Transmission of invasive aspergillosis from a subclinically infected donor to three different organ transplant recipients.
OBJECTIVE
To describe a cluster of donor-transmitted cases of invasive aspergillosis.


METHODS
Case series of epidemiologically linked cases of invasive aspergillosis.


METHODS
Two tertiary care centers with solid-organ transplant programs.


METHODS
Two kidney recipients, one heart recipient, and the single donor.


METHODS
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 had multiple Aspergillus abscesses and had to be removed to cure the patients. The heart recipient had 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.


CONCLUSIONS
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.
Keating
M R
MR
Division of Infectious Diseases, Mayo Medical Center, Rochester, Minn., USA.
Guerrero
M A
MA
Daly
R C
RC
Walker
R C
RC
Davies
S F
SF
D000038:Abscess / Q000382:microbiology; D000328:Adult; D001228:Aspergillosis / Q000635:transmission*; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D003881:Dermatomycoses / Q000473:pathology; D004696:Endocarditis / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000473:pathology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000382:microbiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000382:microbiology / Q000635:transmission*; D014019:Tissue Donors; D014184:Transplantation, Homologous