Transmission of invasive aspergillosis from a subclinically infected donor to three different organ transplant recipients

Michael R. Keating, Marco A. Guerrero, Richard C. Daly, Randall C. Walker, Scott F. Davies

Research output: Contribution to journalArticle

67 Scopus citations

Abstract

Objective: To describe a cluster of donor-transmitted cases of invasive aspergillosis. Design: Case series of epidemiologically linked cases of invasive aspergillosis. Setting: Two tertiary care centers with solid-organ transplant programs. Patients: Two kidney recipients, one heart recipient, and the single donor. Measurements: Routine clinical, microbiological, and pathologic investigation as dictated for patient care. Epidemiologic analysis to establish linkage among cases. Results: Three allografts (two kidneys and a heart) from a single donor transmitted invasive aspergillosis to the recipients. Three weeks after transplantation, the two kidney recipients had fever and urine cultures positive for Aspergillus fumigatus. The infected kidneys bad multiple Aspergillus abscesses and bad to be removed to cure the patients. The heart recipient bad a negative workup when a diagnosis of aspergillosis was made for the kidney recipients but presented three months later with aspergillus endocarditis with hematogenous spread to the eyes and to the skin. Treatment included eye surgery, aortic valve replacement, and antifungal therapy; control of infection ensued. The donor was intensely immunosuppressed (17 days post-liver transplantation with death from intracerebral bleeding) but had no clinical or autopsy evidence of aspergillosis. Donor tracheal secretions obtained at the time of organ harvest later grew A fumigatus. Conclusion: Expanded criteria for organ donation have to be balanced against infectious risk to organ recipients. A fumigatus can be transmitted from a subclinically infected donor to solid- organ transplant recipients.

Original languageEnglish (US)
Pages (from-to)1119-1124
Number of pages6
JournalChest
Volume109
Issue number4
StatePublished - 1996
Externally publishedYes

    Fingerprint

Keywords

  • aspergillosis
  • Aspergillus fumigatus
  • heart transplantation
  • liver transplantation
  • opportunistic infections
  • tissue donors and mycoses

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Keating, M. R., Guerrero, M. A., Daly, R. C., Walker, R. C., & Davies, S. F. (1996). Transmission of invasive aspergillosis from a subclinically infected donor to three different organ transplant recipients. Chest, 109(4), 1119-1124.