title: Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis.
abstract: In April 2014, a kidney transplant recipient in the United States experienced headache, diplopia, and confusion, followed by neurologic decline and death. An investigation to evaluate the possibility of donor-derived infection determined that 3 patients had received 4 organs (kidney, liver, heart/kidney) from the same donor. The liver recipient experienced tremor and gait instability; the heart/kidney and contralateral kidney recipients were hospitalized with encephalitis. None experienced gastrointestinal symptoms. Encephalitozoon cuniculi was detected by tissue PCR in the central nervous system of the deceased kidney recipient and in renal allograft tissue from both kidney recipients. Urine PCR was positive for E. cuniculi in the 2 surviving recipients. Donor serum was positive for E. cuniculi antibodies. E. cuniculi was transmitted to 3 recipients from 1 donor. This rare presentation of disseminated disease resulted in diagnostic delays. Clinicians should consider donor-derived microsporidial infection in organ recipients with unexplained encephalitis, even when gastrointestinal manifestations are absent.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Smith
authors.forename: Atis
authors.initials: A
authors.lastname: Muehlenbachs
authors.forename: Joanna
authors.initials: J
authors.lastname: Schaenmann
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Baxi
authors.forename: Sophia
authors.initials: S
authors.lastname: Koo
authors.forename: Dianna
authors.initials: D
authors.lastname: Blau
authors.forename: Peter
authors.initials: P
authors.lastname: Chin-Hong
authors.forename: Anna R
authors.initials: AR
authors.lastname: Thorner
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kuehnert
authors.forename: Kristina
authors.initials: K
authors.lastname: Wheeler
authors.forename: Alexis
authors.initials: A
authors.lastname: Liakos
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Jackson
authors.forename: Theresa
authors.initials: T
authors.lastname: Benedict
authors.forename: Alexandre J
authors.initials: AJ
authors.lastname: da Silva
authors.forename: Jana M
authors.initials: JM
authors.lastname: Ritter
authors.forename: Dominique
authors.initials: D
authors.lastname: Rollin
authors.forename: Maureen
authors.initials: M
authors.lastname: Metcalfe
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Goldsmith
authors.forename: Govinda S
authors.initials: GS
authors.lastname: Visvesvara
authors.forename: Sridhar V
authors.initials: SV
authors.lastname: Basavaraju
authors.forename: Sherif
authors.initials: S
authors.lastname: Zaki
mesh_terms: D004660:Encephalitis / Q000382:microbiology*; D009670:Encephalitozoon cuniculi; D017809:Fatal Outcome; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D016881:Microsporidiosis / Q000382:microbiology / Q000473:pathology / Q000635:transmission*; D014019:Tissue Donors
keywords: communicable diseases; fungi; meningitis/encephalitis; microsporidia; microsporidiosis; neurologic syndrome; organ transplants