Transmission of Balamuthia mandrillaris through solid organ transplantation

Utility of organ recipient serology to guide clinical management

A. A. Gupte, S. N. Hocevar, Alfred Lea, Rupak Kulkarni, D. C. Schain, M. J. Casey, I. R. Zendejas-Ruiz, W. K. Chung, C. Mbaeyi, S. L. Roy, G. S. Visvesvara, A. J. Da Silva, J. Tallaj, D. Eckhoff, J. W. Baddley

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

A liver, heart, iliac vessel and two kidneys were recovered from a 39-year-old man who died of traumatic head injury and were transplanted into five recipients. The liver recipient 18 days posttransplantation presented with headache, ataxia and fever, followed by rapid neurologic decline and death. Diagnosis of granulomatous amebic encephalitis was made on autopsy. Balamuthia mandrillaris infection was confirmed with immunohistochemical and polymerase chain reaction (PCR) assays. Donor and recipients' sera were tested for B. mandrillaris antibodies. Donor brain was negative for Balamuthia by immunohistochemistry and PCR; donor serum Balamuthia antibody titer was positive (1:64). Antibody titers in all recipients were positive (range, 1:64-1:512). Recipients received a four- to five-drug combination of miltefosine or pentamidine, azithromycin, albendazole, sulfadiazine and fluconazole. Nausea, vomiting, elevated liver transaminases and renal insufficiency were common. All other recipients survived and have remained asymptomatic 24 months posttransplant. This is the third donor-derived Balamuthia infection cluster described in solid organ transplant recipients in the United States. As Balamuthia serologic testing is only available through a national reference laboratory, it is not feasible for donor screening, but may be useful to determine exposure status in recipients and to help guide chemotherapy. This study describes the investigation of a donor-derived Balamuthia infection cluster in solid organ transplant recipients in the United States, and the usefulness of Balamuthia serologic testing to determine exposure status and guide prophylaxis in recipients.

Original languageEnglish (US)
Pages (from-to)1417-1424
Number of pages8
JournalAmerican Journal of Transplantation
Volume14
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Balamuthia mandrillaris
Organ Transplantation
Serology
Tissue Donors
miltefosine
Antibodies
Infection
Sulfadiazine
Hepatic Insufficiency
Pentamidine
Transplants
Donor Selection
Albendazole
Polymerase Chain Reaction
Azithromycin
Fluconazole
Liver
Encephalitis
Drug Combinations
Ataxia

Keywords

  • Amebic encephalitis
  • Balamuthia mandrillaris
  • donor-derived infection
  • miltefosine

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)
  • Medicine(all)

Cite this

Transmission of Balamuthia mandrillaris through solid organ transplantation : Utility of organ recipient serology to guide clinical management. / Gupte, A. A.; Hocevar, S. N.; Lea, Alfred; Kulkarni, Rupak; Schain, D. C.; Casey, M. J.; Zendejas-Ruiz, I. R.; Chung, W. K.; Mbaeyi, C.; Roy, S. L.; Visvesvara, G. S.; Da Silva, A. J.; Tallaj, J.; Eckhoff, D.; Baddley, J. W.

In: American Journal of Transplantation, Vol. 14, No. 6, 2014, p. 1417-1424.

Research output: Contribution to journalArticle

Gupte, AA, Hocevar, SN, Lea, A, Kulkarni, R, Schain, DC, Casey, MJ, Zendejas-Ruiz, IR, Chung, WK, Mbaeyi, C, Roy, SL, Visvesvara, GS, Da Silva, AJ, Tallaj, J, Eckhoff, D & Baddley, JW 2014, 'Transmission of Balamuthia mandrillaris through solid organ transplantation: Utility of organ recipient serology to guide clinical management', American Journal of Transplantation, vol. 14, no. 6, pp. 1417-1424. https://doi.org/10.1111/ajt.12726
Gupte, A. A. ; Hocevar, S. N. ; Lea, Alfred ; Kulkarni, Rupak ; Schain, D. C. ; Casey, M. J. ; Zendejas-Ruiz, I. R. ; Chung, W. K. ; Mbaeyi, C. ; Roy, S. L. ; Visvesvara, G. S. ; Da Silva, A. J. ; Tallaj, J. ; Eckhoff, D. ; Baddley, J. W. / Transmission of Balamuthia mandrillaris through solid organ transplantation : Utility of organ recipient serology to guide clinical management. In: American Journal of Transplantation. 2014 ; Vol. 14, No. 6. pp. 1417-1424.
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abstract = "A liver, heart, iliac vessel and two kidneys were recovered from a 39-year-old man who died of traumatic head injury and were transplanted into five recipients. The liver recipient 18 days posttransplantation presented with headache, ataxia and fever, followed by rapid neurologic decline and death. Diagnosis of granulomatous amebic encephalitis was made on autopsy. Balamuthia mandrillaris infection was confirmed with immunohistochemical and polymerase chain reaction (PCR) assays. Donor and recipients' sera were tested for B. mandrillaris antibodies. Donor brain was negative for Balamuthia by immunohistochemistry and PCR; donor serum Balamuthia antibody titer was positive (1:64). Antibody titers in all recipients were positive (range, 1:64-1:512). Recipients received a four- to five-drug combination of miltefosine or pentamidine, azithromycin, albendazole, sulfadiazine and fluconazole. Nausea, vomiting, elevated liver transaminases and renal insufficiency were common. All other recipients survived and have remained asymptomatic 24 months posttransplant. This is the third donor-derived Balamuthia infection cluster described in solid organ transplant recipients in the United States. As Balamuthia serologic testing is only available through a national reference laboratory, it is not feasible for donor screening, but may be useful to determine exposure status in recipients and to help guide chemotherapy. This study describes the investigation of a donor-derived Balamuthia infection cluster in solid organ transplant recipients in the United States, and the usefulness of Balamuthia serologic testing to determine exposure status and guide prophylaxis in recipients.",
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