Microsporidiosis should be considered in febrile transplant patients when common infections are not found or response to standard therapies is poor, according to an article being published in Annals of Internal Medicine.
Microsporidiosis is an opportunistic infection that can cause a spectrum of disease from mild diarrhea to disseminated, life-threatening infections. The disease is especially serious in immumosuppressed individuals, such as transplant recipients. Researchers conducted an investigation into the cause of febrile illness in three patients receiving solid organs from the same donor. After treatment for suspected brucellosis and other common infection causes, the donor recipients remained ill.
Kidney biopsy samples from one patient tested positive for infection with Encephalitozoon cuniculi, a microsporidial species recognized as a pathogen in humans. Serologic evidence of infection with this microsporidian was found in the donor and all three recipients had the same Encephalitozoon cuniculigenotype, confirming that the infection was transplant-transmitted. Donor-derived disease should be considered when multiple recipients are ill.
Annals of Internal Medicine
Susan N. Hocevar, MD; Christopher D. Paddock, MD; Cedric W. Spak, MD; Randall Rosenblatt, MD; Hector Diaz-Luna, MD; Isabel Castillo, RN, BSN; Sergio Luna, RN; Glen C. Friedman, MD; Suresh Antony, MD; Robyn A. Stoddard, DVM, PhD; Rebekah V. Tiller, MPH; Tammie Peterson, RN, MSN/MPH, CPTC; Dianna M. Blau, DVM, PhD; Rama R. Sriram, BS; Alexandre da Silva, PhD; Marcos de Almeida, PhD; Theresa Benedict, BS; Cynthia S. Goldsmith, MGS; Sherif R. Zaki, MD, PhD; Govinda S. Visvesvara, PhD; Matthew J. Kuehnert, MD. Microsporidiosis Acquired Through Solid Organ Transplantation: A Public Health Investigation. Ann Intern Med. 2014;160(4):213-220-220. doi:10.7326/M13-2226