COMMENTARY

Transplant Safety: Recognizing Donor-Derived Infections

Susan N. Hocevar, MD

Disclosures

February 18, 2014

Editorial Collaboration

Medscape &

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Hello. I am Dr. Susan Hocevar, medical officer for the Centers for Disease Control and Prevention (CDC). I am pleased to speak as part of the CDC Expert Video Commentary Series on Medscape. Today I would like to talk about a new study published in the Annals of Internal Medicine[1] describing the first recognized cluster of transplant-transmitted microsporidiosis linked to a common organ donor.

Microsporidiosis is newly recognized as an emerging transplant-associated disease. These spore-forming organisms, related to fungi, cause a spectrum of disease, from diarrhea to disseminated, life-threatening infections. Microsporidiosis is recognized predominantly among HIV-infected patients but has more recently been noted as an emerging pathogen in other immunosuppressed individuals, including transplant recipients. Microsporidiosis should be kept in mind as a diagnosis for transplant recipients with fever when tests for routinely encountered infections are unrevealing.

Because the United States does not have a formal surveillance system to detect disease transmission from organ transplantation, we depend on astute clinicians to alert public health authorities of unusual infections in transplant patients. It is estimated that 1% of organs transplanted in the United States each year harbor a disease that comes from the donor -- either an infection or cancer. However, this number is probably an underestimate; we only know what is recognized and reported. Examples of transmitted pathogens or diseases from organ transplants include an array of parasites, fungi, bacteria, and viruses -- from emerging and unusual infections such as Balamuthia (a free-living amoeba), rabies, lymphochoriomeningitis virus, and Strongyloides, to the more commonly diagnosed infections such as tuberculosis, West Nile virus, and hepatitis C virus.

In this cluster of microsporidiosis, the donor did not have signs of illness. However, the recipients became ill at approximately the same time; the key is to recognize that the infection might have come from the donor. We want to reiterate that transplant physicians or surgeons and other healthcare professionals should be on the lookout for unusual infections in organ recipients. These infections can appear as fever of unknown origin with graft failure and can mimic organ rejection. No matter what the presenting syndrome looks like, prompt reporting of illness in transplant recipients can rapidly alert other clinicians caring for recipients who received organs from the same donor. This is essential, because rapid recognition, diagnosis, and treatment are the keys to increasing the chance of survival for these very sick patients.

CDC continues to work with the transplant community and clinicians to detect these clusters of transplant-transmitted disease and to minimize the risk for transmission of potentially fatal infections, such as microsporidiosis. For more information on the microsporidiosis cluster, visit the Annals of Internal Medicine Website.

Key messages for providers:

A new publication[1] describes microsporidiosis acquired through solid organ transplantation, a newly recognized threat to transplant patients.

CDC depends on astute clinicians to alert public health authorities of unusual infections transmitted from a donor.

About 1% of organs transplanted in the United States each year harbor an unexpected donor-derived disease -- either infection or cancer.

Pathogens transmitted through organ transplantation have included parasites, fungi, bacteria, and viruses.

Web Resources

CDC Transplant Safety Website

Annals of Internal Medicine: Microsporidiosis Acquired Through Solid Organ Transplantation

Seem DL, Lee I, Umscheid CA, Kuehnert MJ. Public Health Service guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Rep. 2013;128:247-343.

Susan N. Hocevar, MD, is a medical epidemiologist in the Surveillance Branch in the Division of Healthcare Quality Promotion (DHQP), National Center for Emerging and Zoonotic Infections Diseases (NCEZID), Centers for Disease Control and Prevention (CDC). In 2009, Dr. Hocevar began training as an epidemic intelligence (EIS) officer at CDC. After completion of EIS in 2011, she became the investigation lead in the Office of Blood, Organ, and Other Tissue Safety and was responsible for investigation of disease transmissions through organ/tissue transplantation and blood product transfusion. In this role she led investigations of over 70 potential disease transmissions. In 2012, she became the pediatric subject matter expert for healthcare-associated infection surveillance in DHQP focusing on hospitalized children and neonates.

Prior to her work at CDC, Dr. Hocevar trained in general pediatrics at St. Christopher’s Hospital for Children in Philadelphia and then at the Medical University of South Carolina (MUSC) where she completed residency and served as a chief resident. She practiced in adolescent medicine at MUSC until her acceptance into EIS in 2009.

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