2例实体器官移植受者发生严重的非供体来源淋巴细胞性脉络丛脑膜炎病毒感染

Severe Non-Donor-Derived Lymphocytic Choriomeningitis Virus Infection in 2 Solid Organ Transplant Recipients.

作者信息

Sayyad Leanna E, Smith Kami L, Sadigh Katrin S, Cossaboom Caitlin M, Choi Mary J, Whitmer Shannon, Cannon Debi, Krapiunaya Inna, Morales-Betoulle Maria, Annambhotla Pallavi, Basavaraju Sridhar V, Ruberto Irene, Kretschmer Melissa, Gutierrez Nalleli, Zabel Karen, Austin Connie, Sandoval Edith, Servellita Venice, Foresythe Abiodun, Sumimoto Nanami, Aqel Bashar A, Khamash Hasan A, Jadlowiec Carrie C, Grys Thomas E, Jaramillo Andres, Grill Marie F, Montgomery Joel M, Shoemaker Trevor, Klena John D, Chiu Charles Y, Vikram Holenarasipur R

机构信息

Division of High-Consequence Pathogens and Pathology, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

出版信息

Open Forum Infect Dis. 2025 Jan 8;12(2):ofaf002. doi: 10.1093/ofid/ofaf002. eCollection 2025 Feb.

DOI:10.1093/ofid/ofaf002

PMID:39896983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11783784/

Abstract

BACKGROUND

Lymphocytic choriomeningitis virus (LCMV) infection in immunocompromised hosts can result in disseminated disease, meningoencephalitis, and death. Published cases in transplant recipients have been traced to transmission from infected donors. We report 2 cases of serious, non-donor-derived LCMV infection in solid organ transplant recipients.

METHODS

Initial identification of LCMV infection was done by using metagenomic next-generation sequencing (mNGS). Subsequent evaluations and confirmatory testing involved molecular diagnostics, serology, and phylogenetic analysis. A detailed epidemiologic investigation was conducted.

RESULTS

LCMV was detected by mNGS in 2 solid organ transplant recipients from distinct donors. A heart transplant recipient (from donor 1) died of progressive, disseminated LCMV infection, while a kidney transplant recipient (from donor 2) with LCMV meningoencephalitis survived. A multistate laboratory and epidemiologic investigation of both donors and all their organ recipients was initiated. Postmortem samples were obtained from both donors, and pretransplant and/or posttransplant samples were obtained from 5 of the 6 organ recipients. mNGS, serologic, and real-time reverse-transcription polymerase chain reaction testing confirmed LCMV infection in both solid organ transplant recipients. Epidemiologic investigation revealed significant pretransplant rodent exposures for both LCMV-infected recipients. Laboratory studies for the other organ recipients from both donors were negative for LCMV infection.

CONCLUSIONS

Our investigations suggest that LCMV infection in 2 solid organ transplant recipients originated from rodent exposure preceding transplantation and were not donor derived. Although uncommon, healthcare providers should be aware of LCMV-associated serious and life-threatening illness in immunocompromised hosts. Diagnostic modalities are limited to reference laboratories.

摘要

背景

免疫功能低下宿主感染淋巴细胞性脉络丛脑膜炎病毒（LCMV）可导致播散性疾病、脑膜脑炎及死亡。已报道的移植受者病例追溯至来自感染供体的传播。我们报告2例实体器官移植受者发生的严重、非供体来源的LCMV感染。

方法

通过宏基因组下一代测序（mNGS）对LCMV感染进行初步鉴定。后续评估和确证检测包括分子诊断、血清学及系统发育分析。进行了详细的流行病学调查。

结果

mNGS在来自不同供体的2例实体器官移植受者中检测到LCMV。1例心脏移植受者（来自供体1）死于进行性播散性LCMV感染，而1例患有LCMV脑膜脑炎的肾移植受者（来自供体2）存活。对两位供体及其所有器官受者启动了多州实验室及流行病学调查。从两位供体获取了尸检样本，从6位器官受者中的5位获取了移植前和/或移植后样本。mNGS、血清学及实时逆转录聚合酶链反应检测证实两位实体器官移植受者均感染LCMV。流行病学调查显示，两位LCMV感染受者在移植前均有显著的啮齿动物暴露史。对来自两位供体的其他器官受者的实验室检测LCMV感染均为阴性。