title: Microsporidiosis acquired through solid organ transplantation: a public health investigation.
abstract: BACKGROUND
  Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as the cause of a temporally associated cluster of febrile illness among 3 solid organ transplant recipients from a common donor.
  
  
  OBJECTIVE
  To confirm the source of the illness, assess donor and recipient risk factors, and provide therapy recommendations for ill recipients.
  
  
  METHODS
  Public health investigation.
  
  
  METHODS
  Two transplant hospitals and community interview with the deceased donor's family.
  
  
  METHODS
  Three transplant recipients and the organ donor.
  
  
  METHODS
  Specimens were tested for microsporidia by using culture, immunofluorescent antibody, polymerase chain reaction,immunohistochemistry, and electron microscopy. Donor medical records were reviewed and a questionnaire was developed to assess for microsporidial infection.
  
  
  RESULTS
  Kidneys and lungs were procured from the deceased donor and transplanted to 3 recipients who became ill with fever 7 to 10 weeks after the transplant. Results of urine culture, serologic,and polymerase chain reaction testing were positive for E. cuniculi of genotype III in each recipient; the organism was also identified in biopsy or autopsy specimens in all recipients. The donor had positive serologic test results for E. cuniculi. Surviving recipients received albendazole. Donor assessment did not identify factors for suspected E. cuniculi infection.
  
  
  CONCLUSIONS
  Inability to detect organism by culture or polymerase chain reaction in donor due to lack of autopsy specimens.
  
  
  CONCLUSIONS
  Microsporidiosis is now recognized as an emerging transplant-associated disease and should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing. Donor-derived disease is critical to assess when multiple recipients from a common donor are ill.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Hocevar
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.forename: Cedric W
authors.initials: CW
authors.lastname: Spak
authors.forename: Randall
authors.initials: R
authors.lastname: Rosenblatt
authors.forename: Hector
authors.initials: H
authors.lastname: Diaz-Luna
authors.forename: Isabel
authors.initials: I
authors.lastname: Castillo
authors.forename: Sergio
authors.initials: S
authors.lastname: Luna
authors.forename: Glen C
authors.initials: GC
authors.lastname: Friedman
authors.forename: Suresh
authors.initials: S
authors.lastname: Antony
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Stoddard
authors.forename: Rebekah V
authors.initials: RV
authors.lastname: Tiller
authors.forename: Tammie
authors.initials: T
authors.lastname: Peterson
authors.forename: Dianna M
authors.initials: DM
authors.lastname: Blau
authors.forename: Rama R
authors.initials: RR
authors.lastname: Sriram
authors.forename: Alexandre
authors.initials: A
authors.lastname: da Silva
authors.forename: Marcos
authors.initials: M
authors.lastname: de Almeida
authors.forename: Theresa
authors.initials: T
authors.lastname: Benedict
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Goldsmith
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: Govinda S
authors.initials: GS
authors.lastname: Visvesvara
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kuehnert
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D009670:Encephalitozoon cuniculi / Q000302:isolation & purification; D016890:Encephalitozoonosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007668:Kidney / Q000382:microbiology / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008168:Lung / Q000382:microbiology / Q000473:pathology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male
chemical_list: D000935:Antifungal Agents; D015766:Albendazole
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