631. Trypanosoma cruzi infections in solid organ transplant recipients, 2014
Session: Oral Abstract Session: Epidemiology of Transplant Infections
Thursday, October 8, 2015: 3:15 PM
Room: 25--ABC
Background: Infection with the parasite Trypanosoma cruzi, the cause of Chagas disease, can be life-threatening in solid organ transplant (SOT) recipients. Recipients may experience either reactivation of chronic infection or donor-derived infection; both can result in severe parasitemia leading to serious disease and death if untreated. Published recommendations include evaluating donors and recipients from endemic areas for serologic evidence of T. cruzi infection. Post-transplant PCR monitoring of recipients allows for prompt recognition of donor-derived or reactivation infection.

Methods: The Centers for Disease Control and Prevention (CDC) was notified of seropositive donors and potential infections in SOT recipients by organ procurement organizations or transplant centers. CDC provides reference serologic and PCR testing for T. cruzi.

Results: In 2014, CDC was notified of 3 organ donors who were seropositive for T. cruzi on a screening test, resulting in PCR monitoring of 6 SOT recipients. Two of whom (33%), a heart and a liver recipient from the same donor, developed donor-derived T. cruzi infection. Both were treated with benznidazole and cleared the infection without evidence of clinical disease to date. CDC also was notified of 9 chronically infected patients who received heart transplants. Of these, 8 were monitored by PCR for post-transplant reactivation. In total, 4 (44%) of the 9 chronically infected patients had laboratory evidence of reactivation. Three patients had been monitored post-transplant (two following the recommended schedule and one with a delayed start of monitoring). One patient’s infection was identified after symptom onset; the patient had not been monitored post-transplant. Three of the four patients with evidence of reactivation received treatment.

Conclusion: Screening for T. cruzi infection in at-risk organ donors and recipients before transplantation and monitoring recipients post-transplantation allows for early detection of infection and prompt treatment, which has been shown to prevent adverse clinical outcomes. Awareness and implementation of existing recommendations should be encouraged to help protect this vulnerable patient population while allowing organ donations to proceed.

Elizabeth B. Gray, MPH1, Theresa Benedict, BS1, Hilda Rivera, BS1, Shirish Huprikar, MD2, Phillip C. Zakowski, MD3, Bernard Kubak, MD4, Marcus R. Pereira, MD, MPH5, Abhay Dhand, MD6, Evan P. Kransdorf, MD, PhD7, Edward Stenehjem, MD, MSc8, Mary Schmidt, MD, MPH9,10, Shalika Katugaha, MD, FACP9,10, Lisa Stocks, RN, MSN, FNP11, Kristin W. Delli Carpini, MPH12, Joselina R. Fuentes, RN, BSN, CCTC13, Loretta S. Kiros, MBA14 and Susan Montgomery, DVM, MPH1, (1)Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Icahn School of Medicine at Mount Sinai, New York, NY, (3)Tower ID Medical Associates, Los Angeles, CA, (4)Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, (5)Columbia University College of Physicians and Surgeons, New York, NY, (6)Transplant Infectious Diseases, Westchester Medical Center, Valhalla, NY, (7)Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ, (8)Division of Infectious Diseases, Intermountain Medical Center, Murray, UT, (9)Transplant Infectious Diseases, Inova Fairfax Hospital, Falls Church, VA, (10)Infectious Diseases Physicians, Inc, Annandale, VA, (11)Lifesharing, San Diego, CA, (12)LiveOnNY, New York, NY, (13)UCLA Medical Center, Los Angeles, CA, (14)Cedars-Sinai Medical Center, Los Angeles, CA

Disclosures:

E. B. Gray, None

T. Benedict, None

H. Rivera, None

S. Huprikar, None

P. C. Zakowski, None

B. Kubak, None

M. R. Pereira, None

A. Dhand, None

E. P. Kransdorf, None

E. Stenehjem, None

M. Schmidt, None

S. Katugaha, None

L. Stocks, None

K. W. Delli Carpini, None

J. R. Fuentes, None

L. S. Kiros, None

S. Montgomery, None

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