title: Fatal Apophysomyces elegans infection transmitted by deceased donor renal allografts.
abstract: Two patients developed renal mucormycosis following transplantation of kidneys from the same donor, a near-drowning victim in a motor vehicle crash. Genotypically, indistinguishable strains of Apophysomyces elegans were recovered from both recipients. We investigated the source of the infection including review of medical records, environmental sampling at possible locations of contamination and query for additional cases at other centers. Histopathology of the explanted kidneys revealed extensive vascular invasion by aseptate, fungal hyphae with relative sparing of the renal capsules suggesting a vascular route of contamination. Disseminated infection in the donor could not be definitively established. A. elegans was not recovered from the same lots of reagents used for organ recovery or environmental samples and no other organ transplant-related cases were identified. This investigation suggests either isolated contamination of the organs during recovery or undiagnosed disseminated donor infection following a near-drowning event. Although no changes to current organ recovery or transplant procedures are recommended, public health officials and transplant physicians should consider the possibility of mucormycosis transmitted via organs in the future, particularly for near-drowning events. Attention to aseptic technique during organ recovery and processing is re-emphasized.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA. alexa011@mc.duke.edu
authors.forename: B D
authors.initials: BD
authors.lastname: Alexander
authors.forename: W A
authors.initials: WA
authors.lastname: Schell
authors.forename: A M
authors.initials: AM
authors.lastname: Siston
authors.forename: C Y
authors.initials: CY
authors.lastname: Rao
authors.forename: W A
authors.initials: WA
authors.lastname: Bower
authors.forename: S A
authors.initials: SA
authors.lastname: Balajee
authors.forename: D N
authors.initials: DN
authors.lastname: Howell
authors.forename: Z S
authors.initials: ZS
authors.lastname: Moore
authors.forename: J
authors.initials: J
authors.lastname: Noble-Wang
authors.forename: J A
authors.initials: JA
authors.lastname: Rhyne
authors.forename: A T
authors.initials: AT
authors.lastname: Fleischauer
authors.forename: J M
authors.initials: JM
authors.lastname: Maillard
authors.forename: M
authors.initials: M
authors.lastname: Kuehnert
authors.forename: D
authors.initials: D
authors.lastname: Vikraman
authors.forename: B H
authors.initials: BH
authors.lastname: Collins
authors.forename: C E
authors.initials: CE
authors.lastname: Marroquin
authors.forename: B J
authors.initials: BJ
authors.lastname: Park
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007668:Kidney / Q000382:microbiology / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000635:transmission*; D015701:Near Drowning / Q000150:complications* / Q000209:etiology / Q000628:therapy; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D014184:Transplantation, Homologous