title: Severe life-threatening Ehrlichia chaffeensis infections transmitted through solid organ transplantation.
abstract: BACKGROUND
  Donor-derived infections from organ transplantation are rare occurrences with preoperative screening practices. Ehrlichia chaffeensis, a tick-borne illness, transmitted through solid organ transplantation has not been reported previously to our knowledge. We present cases of 2 renal allograft recipients who developed severe E. chaffeensis infection after receipt of organs from a common deceased donor.
  
  
  METHODS
  The 2 renal transplant patients who developed E. chaffeensis infection are reported in case study format with review of the literature.
  
  
  RESULTS
  Approximately 3 weeks after renal transplantation, both patients developed an acute febrile illness and rapid clinical decline. Recipient A underwent an extensive infectious workup that revealed positive E. chaffeensis DNA from polymerase chain reaction on peripheral blood. Recipient B's clinical team obtained acute and convalescent antibody titers for E. chaffeensis, which demonstrated acute infection. Recipients A and B were treated with doxycycline and tigecycline, respectively, with clinical cure.
  
  
  CONCLUSIONS
  These cases demonstrate that tick-borne pathogens, such as E. chaffeensis, can be transmitted through renal transplantation. E. chaffeensis can be associated with excessive morbidity and mortality, commonly owing to delay in diagnosis and poor response to non-tetracycline antibiotics. In populations with endemic tick-borne illness, donors should be questioned about tick exposure, and appropriate antibiotics can be administered if indicated.
authors: Nephrology, Department of Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA.
authors: S H
authors: SH
authors: Sachdev
authors: V
authors: V
authors: Joshi
authors: E R
authors: ER
authors: Cox
authors: A
authors: A
authors: Amoroso
authors: S
authors: S
authors: Palekar
mesh_terms: D018469:Ehrlichia chaffeensis / Q000302:isolation & purification*; D016873:Ehrlichiosis / Q000209:etiology / Q000635:transmission*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D019737:Transplants / Q000382:microbiology*
keywords: Ehrlichia chaffeensis; human monocytic ehrlichiosis; solid organ transplant; tick-borne illness; transplant infection