Emerging infectious diseases · 2017
Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis.
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Smith Rachel M, Muehlenbachs Atis, Schaenmann Joanna, Baxi Sanjiv, Koo Sophia, Blau Dianna, Chin-Hong Peter, Thorner Anna R, Kuehnert Matthew J, Wheeler Kristina, Liakos Alexis, Jackson Jonathan W, Benedict Theresa, da Silva Alexandre J, Ritter Jana M, Rollin Dominique, Metcalfe Maureen, Goldsmith Cynthia S, Visvesvara Govinda S, Basavaraju Sridhar V, Zaki Sherif
Аннотация
In April 2014, a kidney transplant recipient in the United States experienced headache, diplopia, and confusion, followed by neurologic decline and death. An investigation to evaluate the possibility of donor-derived infection determined that 3 patients had received 4 organs (kidney, liver, heart/kidney) from the same donor. The liver recipient experienced tremor and gait instability; the heart/kidney and contralateral kidney recipients were hospitalized with encephalitis. None experienced gastrointestinal symptoms. Encephalitozoon cuniculi was detected by tissue PCR in the central nervous system of the deceased kidney recipient and in renal allograft tissue from both kidney recipients. Urine PCR was positive for E. cuniculi in the 2 surviving recipients. Donor serum was positive for E. cuniculi antibodies. E. cuniculi was transmitted to 3 recipients from 1 donor. This rare presentation of disseminated disease resulted in diagnostic delays. Clinicians should consider donor-derived microsporidial infection in organ recipients with unexplained encephalitis, even when gastrointestinal manifestations are absent.