title: Transmission of Balamuthia mandrillaris by Organ Transplantation.
abstract: During 2009 and 2010, 2 clusters of organ transplant-transmitted Balamuthia mandrillaris, a free-living ameba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor.
  
  
  
  We investigated all recipients and the 2 donors through interview, medical record review, and testing of available specimens retrospectively. Surviving recipients were tested and treated prospectively.
  
  
  
  In the 2009 cluster of illness, 2 kidney recipients were infected and 1 died. The donor had Balamuthia encephalitis confirmed on autopsy. In the 2010 cluster, the liver and kidney-pancreas recipients developed Balamuthia encephalitis and died. The donor had a clinical syndrome consistent with Balamuthia infection and serologic evidence of infection. In both clusters, the 2 asymptomatic recipients were treated expectantly and survived; 1 asymptomatic recipient in each cluster had serologic evidence of exposure that decreased over time. Both donors had been presumptively diagnosed with other neurologic diseases prior to organ procurement.
  
  
  
  Balamuthia can be transmitted through organ transplantation with an observed incubation time of 17-24 days. Clinicians should be aware of Balamuthia as a cause of encephalitis with high rate of fatality, and should notify public health departments and evaluate transplant recipients from donors with signs of possible encephalitis to facilitate early diagnosis and targeted treatment. Organ procurement organizations and transplant centers should be aware of the potential for Balamuthia infection in donors with possible encephalitis and also assess donors carefully for signs of neurologic infection that may have been misdiagnosed as stroke or as noninfectious forms of encephalitis.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Eileen C
authors.initials: EC
authors.lastname: Farnon
authors.affiliation: University of Mississippi Medical Center, Jackson.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Kokko
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Budge
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Chukwuma
authors.initials: C
authors.lastname: Mbaeyi
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.|Kentucky Department for Public Health, Frankfort.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Lutterloh
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Qvarnstrom
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Alexandre J
authors.initials: AJ
authors.lastname: da Silva
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Roy
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Rama
authors.initials: R
authors.lastname: Sriram
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Govinda S
authors.initials: GS
authors.lastname: Visvesvara
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kuehnert
authors.forename: Joli
authors.initials: J
authors.lastname: Weiss
authors.forename: Ken
authors.initials: K
authors.lastname: Komatsu
authors.forename: Richard
authors.initials: R
authors.lastname: Manch
authors.forename: Alberto
authors.initials: A
authors.lastname: Ramos
authors.forename: Leonor
authors.initials: L
authors.lastname: Echeverria
authors.forename: Ann
authors.initials: A
authors.lastname: Moore
authors.forename: Phil
authors.initials: P
authors.lastname: Zakowski
authors.forename: Michelle
authors.initials: M
authors.lastname: Kittleson
authors.forename: Jon
authors.initials: J
authors.lastname: Kobashigawa
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yoder
authors.forename: Michael
authors.initials: M
authors.lastname: Beach
authors.forename: William
authors.initials: W
authors.lastname: Mahle
authors.forename: Kirk
authors.initials: K
authors.lastname: Kanter
authors.forename: P J
authors.initials: PJ
authors.lastname: Geraghty
authors.forename: Eileen
authors.initials: E
authors.lastname: Navarro
authors.forename: Christine
authors.initials: C
authors.lastname: Hahn
authors.forename: Shiro
authors.initials: S
authors.lastname: Fujita
authors.forename: Jim
authors.initials: J
authors.lastname: Stinson
authors.forename: Joel
authors.initials: J
authors.lastname: Trachtenberg
authors.forename: Paul
authors.initials: P
authors.lastname: Byers
authors.forename: Michele
authors.initials: M
authors.lastname: Cheung
authors.forename: Tun
authors.initials: T
authors.lastname: Jie
authors.forename: Bruce
authors.initials: B
authors.lastname: Kaplan
authors.forename: Rainer
authors.initials: R
authors.lastname: Gruessner
authors.forename: Erica
authors.initials: E
authors.lastname: Bracamonte
authors.forename: Chad
authors.initials: C
authors.lastname: Viscusi
authors.forename: Regino
authors.initials: R
authors.lastname: Gonzalez-Peralta
authors.forename: Robert
authors.initials: R
authors.lastname: Lawrence
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fratkin
authors.forename: Fauzia
authors.initials: F
authors.lastname: Butt
mesh_terms: D000328:Adult; D000562:Amebiasis / Q000000981:diagnostic imaging / Q000473:pathology / Q000635:transmission; D059611:Balamuthia mandrillaris; D001921:Brain / Q000000981:diagnostic imaging / Q000469:parasitology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D066027:Transplant Recipients
keywords: Balamuthia; donor-derived infection; encephalitis; organ transplantation; transplant-transmitted