Use of Organs for Transplantation from a Donor with Primary Meningoencephalitis due to Naegleria fowleri

Abstract

Naegleria fowleri is a free-living amebic organism that causes acute meningoencephalitis and brain death in young people. Though this infection is limited to the central nervous system, organ donation is usually ruled out because of the infectious nature of the donor's death. Based on the realization that this organism is limited to the brain, we successfully transplanted organs from a 12-year-old male donor dying of N. fowleri infection. Kidneys, pancreas, a lung and liver were used with no evidence of posttransplant infectious complications. This unusual cause of brain death does not preclude successful organ donation. Naegleria fowleri is a free-living ameba parasite. It is designated free-living because it can survive and replicate without requiring a host. This organism is found worldwide usually in bodies of water with relatively high temperatures. In endemic areas the organism can rarely be isolated from healthy individuals and such individuals often have antibodies to the organism (1). Occasionally (about 100 cases in the United States) a devastating rapidly fatal primary amebic meningoencephalitis occurs in children and young adults with a history of diving into lakes, ponds or swimming pools that have not been adequately chlorinated. The organism presumably gains access to the central nervous system via the olfactory epithelium, migrates to the cribiform plate then entering the brain. The incubation period between exposure and clinical manifestation varies from 1 day to 1 week. The patient presents with headache, fever, stiff neck and nausea and vomiting. Progressive neurological deterioration, coma and death occur within a few days in 95% of cases. The cause of death is brain herniation usually due to increased intra-cranial pressure (2). There are no reports of extra-CNS infections with this agent.In the past few years, increased numbers of cases have been reported from Florida, Texas and Arizona. Because of the infectious nature of the death, organs have been thought to be unusable for transplantation. There is one prior case of such organs being used prior to knowing the Naegleria diagnosis (3).We report a case of a 12-year-old male donor in Texas who had confirmed N. fowleri infection. The pre-mortem diagnosis was made based on motile amoebae in cerebrospinal fluid and confirmed by the Texas State Parasitology Laboratory. The organs were offered to multiple local and national transplant centers. Because of the perceived risk of infection for potential recipients, the offers were declined. Based on the epidemiology of N. fowleri infection as an exclusively central nervous system infection without systemic manifestations, we accepted both kidneys at our center. After informed consent by the transplant physicians from both patients, the kidneys were transplanted into a 29-year-old male with severe malignant hypertension and a 46-year-old male with IgA nephropathy. Despite cold ischemia times of 36 and 39 h, the kidneys functioned promptly and at 180 days posttransplant had serum creatinines of 1.2 an...

Detection rates of waterborne protozoa in water sources from Fayoum Governorate

“…[16] . Identification was based on the morphological characteristics of trophic, temporary flagellate and cyst stages [17,18] .…”

Importance of Nonenteric Protozoan Infections in Immunocompromised People

“…To our knowledge, only one case of PAM has been reported for an HIV-infected patient, and parasitic involvement was restricted to the CNS (110). Furthermore, one study described a case where an organ donor had died of PAM, but the single recipient of the kidneys, pancreas, a lung, and liver failed to contract PAM (38,379).…”

Update on donor-derived infections in liver transplantation

“…Existing data suggest that donors with proven Naegleria meningoencephalitis, even if it is the cause of death, can be safely used with a low risk of transmission as long as the recipients are informed of the risk and monitored closely. 123,124…”