Solid Organ Transplant-Transmitted Tuberculosis Linked to a Community Outbreak - California, 2015.

Alexander Kay,Carol Greene,Tambi Shaw,Matthew Kuehnert,Pennan M Barry,Nikole Neidlinger,Nicholas Arger,Neha Shah,Pallavi Annambhotla,Sridhar V Basavaraju,Louise Mcnitt,Peter Chin-Hong,Martin Cilnis

doi:10.15585/mmwr.mm6630a1

Abstract

In the spring of 2015, a local health department (LHD) in county A notified the California Department of Public Health (CDPH) about three adults with close ties to one another and a congregate community site who had received diagnoses of tuberculosis (TB) disease within a 3-month period. Subsequent review revealed matching TB genotypes indicating that the cases were likely part of a chain of TB transmission. Only three TB cases in California in the preceding 2 years shared this same genotype. One of those three previous cases occurred in a lung-transplant recipient who had no identified epidemiologic links to the outbreak. CDPH, multiple LHDs, and CDC conducted an investigation and determined that the lung-transplant donor (patient 1) was epidemiologically linked to the three outbreak cases and had a tuberculin skin test (TST) conversion detected in 2012 upon reentry at a local jail. Three other solid organ recipients from this donor were identified; none had developed TB disease. This investigation suggests that review of organ donors' medical records from high-risk environments, such as jails, might reveal additional information about TB risk. The evaluation of TB in organ recipients could include genotyping analysis (1) and coordination among local, state, and national partners to evaluate the potential for donor-derived TB.

Highlights

To prevent future transmissions, if there is clinical suspicion, organ procurement organizations or transplant centers might work with the TB control program in the donor’s state or county of residence to seek further information regarding TB risk (6)
What is already known about this topic
When donor-derived TB disease is identified in an organ recipient

Summary

Introduction

If there is clinical suspicion, organ procurement organizations or transplant centers might work with the TB control program in the donor’s state or county of residence to seek further information regarding TB risk (6). Even delayed reporting to transplant centers could prevent TB-related morbidity and mortality among recipients through testing and empiric treatment for LTBI. Organ procurement organizations and transplant centers could obtain and review medical records from previous medical homes and from high-risk settings such as jails and prisons to ascertain TB risk. This might not be feasible for most organ donors

Results

Discussion

Conclusion