1 Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI. 2 United Network for Organ Sharing, Richmond, VA. 3 Department of Pediatrics and Surgery, Division of Pediatric Infectious Diseases, University of Pittsburgh Medical School, Pittsburgh, PA. 4 Department of Internal Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. 5 Division of Infectious Diseases, Mayo Clinic in Arizona, Phoenix, AZ. 6 Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA. 7 Department of Medicine, Division of Infectious Disease, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. 8 Address correspondence to: Daniel R. Kaul, M.D., Division of Infectious Diseases, University of Michigan Medical Center, 3120 Taubman Center, 1500 E. Medical Center Dr., SPC 5378, Ann Arbor, MI.
Transplantation. 2014 Sep 27;98(6):666-70. doi: 10.1097/TP.0000000000000117.
While donor-derived infections (DDI) remain uncommon, multiple reports describe DDI with pathogens that cause central nervous system (CNS) infection resulting in significant recipient disease. The Ad Hoc Disease Transmission Advisory Committee (DTAC) reviewed the records of potential donor-derived disease transmission events (PDDTE) to describe donor characteristics and outcomes associated with DDI from CNS pathogens.
All PDDTE reported from January 2008 to September 2010 were reviewed for characteristics suggesting CNS infection in the donor or the recipient. Identified cases were further examined to determine if donor CNS infection resulted in recipient infection.
Ninety-one PDDTE cases in which there was concern for CNS infection in the donor or recipient were identified. Further review confirmed CNS infection in 12 donors, six of whom transmitted infection to 10 of 15 exposed recipients with five recipient deaths. Pathogens included Balamuthia mandrillaris, Cryptococcus neoformans, lymphocytic choriomeningitis virus, and West Nile virus. Listed cause of death at procurement for these donors included stroke, anoxia, acute disseminated encephalomyelitis, and meningoencephalitis. Confounding diagnoses were present in 6 of 12 donors that would have allowed them to be considered at low risk of transmitting a CNS pathogen. Of the six donors with no confounding conditions, three exhibited at least two suspicious "DTAC warning criteria" for CNS infection.
Careful clinical assessment of donors combined with a high index of suspicion for ambiguous or misleading findings associated with CNS infection can reduce, but not eliminate, DDI with CNS pathogens.
尽管供体源性感染（DDI）仍然很少见，但有多个报告描述了导致中枢神经系统（CNS）感染的病原体引起的 DDI，从而导致受者发生严重疾病。专门的疾病传播咨询委员会（DTAC）审查了潜在供体源性疾病传播事件（PDDTE）的记录，以描述与 CNS 病原体相关的 DDI 的供体特征和结果。
对 2008 年 1 月至 2010 年 9 月报告的所有 PDDTE 进行了回顾，以评估供体或受者中存在 CNS 感染的特征。对确定的病例进行进一步检查，以确定供体的 CNS 感染是否导致受者感染。
确定了 91 例供体或受者存在 CNS 感染疑似的 PDDTE 病例。进一步审查证实了 12 例供体存在 CNS 感染，其中 6 例将感染传播给 15 例暴露受者中的 10 例，导致 5 例受者死亡。病原体包括狒狒 Mandrillaris 原虫、新型隐球菌、淋巴细胞性脉络丛脑膜炎病毒和西尼罗河病毒。这些供体在采购时的死亡原因包括中风、缺氧、急性播散性脑脊髓炎和脑膜脑炎。在 12 例供体中有 6 例存在混淆诊断，这些供体可能被认为传播 CNS 病原体的风险较低。在没有混淆情况的 6 例供体中，有 3 例至少表现出两个可疑的“DTAC 警告标准”，提示 CNS 感染。
仔细评估供体的临床情况，对与 CNS 感染相关的不明确或误导性发现保持高度怀疑，可以减少但不能消除 CNS 病原体的 DDI。
