title: Three cases of donor-derived pulmonary tuberculosis in lung transplant recipients and review of 12 previously reported cases: opportunities for early diagnosis and prevention.
abstract: BACKGROUND
  Solid organ transplant recipients have a higher frequency of tuberculosis (TB) than the general population, with mortality rates of approximately 30%. Although donor-derived TB is reported to account for <5% of TB in solid organ transplants, the source of Mycobacterium tuberculosis infection is infrequently determined.
  
  
  METHODS
  We report 3 new cases of pulmonary TB in lung transplant recipients attributed to donor infection, and review the 12 previously reported cases to assess whether cases could have been prevented and whether any cases that might occur in the future could be detected and investigated more quickly. Specifically, we evaluate whether opportunities existed to determine TB risk on the basis of routine donor history, to expedite diagnosis through routine mycobacterial smears and cultures of respiratory specimens early post transplant, and to utilize molecular tools to investigate infection sources epidemiologically.
  
  
  RESULTS
  On review, donor TB risk was present among 7 cases. Routine smears and cultures diagnosed 4 asymptomatic cases. Genotyping was used to support epidemiologic findings in 6 cases.
  
  
  CONCLUSIONS
  Validated screening protocols, including microbiological testing and newer technologies (e.g., interferon-gamma release assays) to identify unrecognized M. tuberculosis infection in deceased donors, are warranted.
authors.affiliation: Epidemic Intelligence Service Field Assignments Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: E
authors.initials: E
authors.lastname: Mortensen
authors.forename: W
authors.initials: W
authors.lastname: Hellinger
authors.forename: C
authors.initials: C
authors.lastname: Keller
authors.forename: L S
authors.initials: LS
authors.lastname: Cowan
authors.forename: T
authors.initials: T
authors.lastname: Shaw
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: D
authors.initials: D
authors.lastname: Pegues
authors.forename: S
authors.initials: S
authors.lastname: Ahmedov
authors.forename: M
authors.initials: M
authors.lastname: Salfinger
authors.forename: W A
authors.initials: WA
authors.lastname: Bower
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D019737:Transplants / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents
keywords: Mycobacterium tuberculosis; donor selection; interferon gamma release assay; lung transplantation