Abstract
The cause of encephalitis among solid organ transplant recipients may be multifactorial; the disease can result from infectious or noninfectious etiologies. During 2002-2013, the US Centers for Disease Control and Prevention investigated several encephalitis clusters among transplant recipients. Cases were caused by infections from transplant-transmitted pathogens: West Nile virus, rabies virus, lymphocytic choriomeningitis virus, and Balamuthia mandrillaris amebae. In many of the clusters, identification of the cause was complicated by delayed diagnosis due to the rarity of the disease, geographic distance separating transplant recipients, and lack of prompt recognition and reporting systems. Establishment of surveillance systems to detect illness among organ recipients, including communication among transplant center physicians, organ procurement organizations, and public health authorities, may enable the rapid discovery and investigation of infectious encephalitis clusters. These transplant-transmitted pathogen clusters highlight the need for greater awareness among clinicians, pathologists, and public health workers, of emerging infectious agents causing encephalitis among organ recipients.
Highlights
The cause of encephalitis among solid organ transplant recipients may be multifactorial; the disease can result from infectious or noninfectious etiologies
Improvements in immune-modulating therapy, critical care medicine, and surgical techniques have led to the increased success of organ transplantations, and more patients are eligible for these procedures
These cases can present a diagnostic challenge for clinicians and highlight the need to increase awareness among transplant clinicians regarding the necessity for prompt recognition and treatment of transplanttransmitted infections
Summary
The cause of encephalitis among solid organ transplant recipients may be multifactorial; the disease can result from infectious or noninfectious etiologies. We review the emerging infectious agents known to cause transplant-transmitted encephalitis, as described from several recent outbreak clusters reported to and investigated by CDC, and suggest methods for better identifying possible donor-derived infections. Recognition of the second cluster demonstrates the potential ability to improve clinical recognition and diagnosis of transplant-transmitted encephalitis through increased awareness generated from knowledge of previous transmission events [24] In these 2 clusters of solid organ transplant–transmitted rabies cases, infection was attributed to bat and canine virus variants, respectively. The donor was homeless and likely had multiple opportunities for exposure to rodents [31] Another cluster of infections with a novel LCMVrelated virus among 3 organ transplant recipients was reported in Australia; the patients died of encephalitis within 6 weeks of undergoing transplantation [32]. Unlike other free-living amebae, which are typically found in fresh water, the natural reservoir for Balamuthia amebae is believed to be the soil
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
