Microsporidiosis Acquired Through Solid Organ Transplantation

Abstract

Background Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as the cause of a temporally associated cluster of febrile illness among 3 solid organ transplant recipients from a common donor. Objective To confirm the source of the illness, assess donor and recipient risk factors, and provide therapy recommendations for ill recipients. Design Public health investigation. Setting Two transplant hospitals and community interview with the deceased donor’s family. Patients Three transplant recipients and the organ donor. Measurements Specimens were tested for microsporidia by using culture, immunofluorescent antibody, polymerase chain reaction, immunohistochemistry, and electron microscopy. Donor medical records were reviewed and a questionnaire was developed to assess for microsporidial infection. Results Kidneys and lungs were procured from the deceased donor and transplanted to 3 recipients who became ill with fever 7 to 10 weeks after the transplant. Results of urine culture, serologic, and polymerase chain reaction testing were positive for Encephalitozoon cuniculi of genotype III in each recipient; the organism was also identified in biopsy or autopsy specimens in all recipients. The donor had positive serologic test results for Encephalitozoon cuniculi. Surviving recipients received albendazole. Donor assessment did not identify factors for suspected Encephalitozoon cuniculi infection. Limitation Inability to detect organism by culture or polymerase chain reaction in donor due to lack of autopsy specimens. Conclusion Transmission of microsporidiosis through organ transplantation is described. Microsporidiosis is now recognized as an emerging transplant-associated disease and should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing. Donor-derived disease is critical to assess when multiple recipients from a common donor are ill. Primary Funding Source None.

Evaluation of pulmonary microsporidiosis in iatrogenically immunosuppressed patients

“…It is generally observed in patients with AIDS and transplant recipients, may vary from asymptomatic colonization to death from cardiopulmonary failure (7)(8)(9)(10)(22)(23)(24)(25)(26). On the other hand there has been only one study on the prevalence of pulmonary microsporidiosis.…”

Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis

“…IHC was performed by using a polymer-based indirect immunoalkaline phosphatase detection system with a fast red chromogen kit (Biocare Medical, Concord, CA, USA). The microsporidia IHC assay used rabbit anti– E. cuniculi serum at a 1:1,000 dilution as previously described ( 7 ). In addition, IHC assays for lymphocytic choriomeningitis virus, measles virus, and Trypanosoma cruzi were performed as previously described ( 8 – 10 ).…”

“…DNA was extracted from the formalin-fixed paraffin-embedded tissues by using a QIAamp DNA Mini Kit (QIAGEN) as previously described ( 7 , 12 ). PCR primers (concentration 15 μmol/L each) specific for E. cuniculi small subunit ribosomal RNA gene were used ( 7 , 12 ). We performed PCR by using AmpliTaq Gold PCR Master Mix (ThermoFisher Scientific, Grand Island, NY, USA) and 5 μmol of each primer at an annealing temperature of 65°C.…”

Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks

“…Microsporidiosis also appears to be an emerging donor-derived IFI; in the first known donor-derived cluster of this infection, three transplant recipients developed Encephalitozoon cuniculi infection after receiving organs from the same donor. 74 Recognition of IFIs transmitted through infected organs remains challenging, since distinguishing these infections from IFI acquired post-transplantation or reactivation of latent IFI can be difficult. Further efforts to improve recognition of these infections, including determining the importance of donor screening practices, are needed.…”