Risk for Transmission of Naegleria fowleri From Solid Organ Transplantation

• Type of Material: Article
• Authors: SL Roy, Centers for Disease Control and Prevention; R Metzger, TransLife Organ Procurement Organization; JG Chen, Arnold Palmer Hospital for Children; FR Laham, Arnold Palmer Hospital for Children; M Martin, Arnold Palmer Hospital for Children; SW Kipper, Sedgwick County Regional Forensic Science Center; LE Smith, Wesley Medical Center; George Lyon III, Emory University; J Haffner, Tampa General Hospital; JE Ross, Newberry Pathology Associates; AK Rye, University of South Carolina; W Johnson, TransLife Organ Procurement Organization; D Bodager, Florida Department of Health; M Friedman, Florida Department of Health; DJ Walsh, Orange County Health Department, Florida; C Collins, Polk County Health Department, Florida; B Inman, Brevard County Health Department, Florida; BJ Davis, Essentia Health; T Robinson, Minnesota Department of Health; IC Paddock, Centers for Disease Control and Prevention; SR Zaki, Centers for Disease Control and Prevention; M Kuehnert, Centers for Disease Control and Prevention; A DaSilva, Centers for Disease Control and Prevention; Y Qvarnstrom, Centers for Disease Control and Prevention; R Sriram, Centers for Disease Control and Prevention; GS Visvesvara, Centers for Disease Control and Prevention
• Language: English
• Date: 2014-01-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.
• Final Published Version (URL): http://dx.doi.org/10.1111/ajt.12536
• Title of Journal or Parent Work: American Journal of Transplantation
• ISSN: 1600-6135
• Volume: 14
• Issue: 1
• Start Page: 163
• End Page: 171
• Keywords: amoeba; ACANTHAMOEBA SPP.; primary amebic meningoencephalitis; disseminated; Transplantation; transplant; PRIMARY AMEBIC MENINGOENCEPHALITIS; DONOR; Science & Technology; SURGERY; TRANSPLANTATION; Ameba; Naegleria; Life Sciences & Biomedicine; Surgery; BALAMUTHIA-MANDRILLARIS; MICE; VIRUS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pathology

Abstract

Primary amebic meningoencephalitis (PAM) caused by the free-living ameba (FLA) Naegleria fowleri is a rare but rapidly fatal disease of the central nervous system (CNS) affecting predominantly young, previously healthy persons. No effective chemotherapeutic prophylaxis or treatment has been identified. Recently, three transplant-associated clusters of encephalitis caused by another FLA, Balamuthia mandrillaris, have occurred, prompting questions regarding the suitability of extra-CNS solid organ transplantation from donors with PAM. During 1995-2012, 21 transplant recipients of solid organs donated by five patients with fatal cases of PAM were reported in the United States. None of the recipients developed PAM, and several recipients tested negative for N. fowleri by serology. However, historical PAM case reports and animal experiments with N. fowleri, combined with new postmortem findings from four patients with PAM, suggest that extra-CNS dissemination of N. fowleri can occur and might pose a risk for disease transmission via transplantation. The risks of transplantation with an organ possibly harboring N. fowleri should be carefully weighed for each individual recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. In this article, we present a case series and review existing data to inform such risk assessments. Although Naegleria fowleri solid organ transplant transmission has not been reported to date, human postmortem findings and animal studies suggest that N. fowleri extra-CNS dissemination can occur; therefore the risks of transplantation with an organ from a patient with primary amebic meningoencephalitis should be carefully weighed against the potentially greater risk of delaying transplantation while waiting for another suitable organ.