1342. An uncommon cause of donor-derived central nervous system infection in multiple organ transplant recipients 
Session: Oral Abstract Session: CNS Infections
Saturday, October 10, 2015: 9:30 AM
Room: 7--AB
Background: Donor-derived infections are estimated to complicate 1-2% of solid organ transplants, and can result in allograft failure or recipient death.  In April 2014, CDC was notified of a male kidney transplant recipient who presented with altered mental status and developed fever and CSF pleocytosis leading to progressive neurologic decline and death. Extensive pre-mortem diagnostic testing was unrevealing. The donor was a 43 yo woman who died of an aneurysm-associated hemorrhagic stroke, experiencing vision loss, headache, seizures and diplopia prior to death. We investigated to determine the etiology of suspected recipient encephalitis and the possibility of donor-derived infection.

Methods: Donor and recipients’ medical records were reviewed. Available donor and recipient specimens were evaluated at CDC using histopathology, immunohistochemistry (IHC), PCR and immunofluorescence assay (IFA). Donor family members were interviewed to ascertain potential infectious disease risk factors.

Results: Three recipients received 4 solid organs (kidney, liver, heart/kidney). The liver recipient experienced post-transplant tremor and gait instability; the heart/kidney recipient was hospitalized for encephalitis. None of the recipients experienced gastrointestinal symptoms.  Encephalitozoon cuniculi was detected in the deceased donor’s central nervous system tissue as well as in renal allograft tissue from both kidney recipients by tissue PCR and IHC. Urine PCR was positive for E. cuniculi in both surviving recipients. Donor serum was positive for E.cuniculiantibodies by IFA with a titer of 1:2048. The time between symptom onset and diagnosis ranged from 1 – 2 months among the recipients. The surviving recipients received albendazole with resolution of neurologic symptoms. No microsporidia risk factors were identified by the donor next of kin.

Conclusion: Microsporidial infection was transmitted to three recipients from a single infected donor. This rare presentation of disseminated disease, manifesting as only severe neurologic symptoms, resulted in diagnostic and treatment delays. Clinicians should consider donor-derived microsporidia infection in organ donors and recipients with unexplained encephalitis and should be aware that gastrointestinal manifestations may be absent.

Rachel M. Smith, MD, MPH1, Dianna M. Blau, DVM, PhD2, Joanna Schaenman, MD PhD3, Sanjiv Baxi, MS, MD, MPH4, Sophia Koo, MD5,6,7, Peter Chin-Hong, MD8, Anna R. Thorner, MD, FIDSA6,9,10, Alexis Liakos, PA-C5,7, Matthew J. Kuehnert, MD, FIDSA11, Kristina Wheeler, RN, BSN12, Jonathan W. Jackson, BS13, Theresa Benedict, BS14, Alexandre Dasilva, PhD14, Jana M. Ritter, DVM2, Atis Muehlenbachs, MD, PhD15, Dominique Rollin, MD2, Maureen Metcalfe, MS2, Govinda S. Visvesvara, PhD16, Sridhar Basavaraju, MD, FACEP11 and Sherif R. Zaki, MD, PhD2, (1)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, (3)Medicine/Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, (4)Department of Medicine, The University of California at San Francisco, San Francisco, CA, (5)Infectious Diseases, Dana-Farber Cancer Institute, Boston, MA, (6)Harvard Medical School, Boston, MA, (7)Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, (8)Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, (9)Brigham and Women's Hospital, Boston, MA, (10)Dana-Farber Cancer Institute, Boston, MA, (11)Office of Blood, Organ, and Other Tissue Safety, Centers for Disease Control and Prevention, Atlanta, GA, (12)One Legacy, Los Angeles, CA, (13)8Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA, (14)Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (15)Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, (16)Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

R. M. Smith, None

D. M. Blau, None

J. Schaenman, None

S. Baxi, None

S. Koo, None

P. Chin-Hong, None

A. R. Thorner, None

A. Liakos, None

M. J. Kuehnert, None

K. Wheeler, None

J. W. Jackson, None

T. Benedict, None

A. Dasilva, None

J. M. Ritter, None

A. Muehlenbachs, None

D. Rollin, None

M. Metcalfe, None

G. S. Visvesvara, None

S. Basavaraju, None

S. R. Zaki, None

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