Olen - 29/09/2016 - 00:06

Adverse Occurrence type: 
MPHO Type: 
Estimates Frequency: 
In this case there were two episodes of transmission from a donor to the liver and a kidney transplant recipients. The other kidney recipients did not presented the infection.
Time to detection: 
The liver transplant recipient was diagnosed of being affected with C. immitis infection in the postmortem examination on day +17. The kidney transplant recipient was also diagnosed after his death in the autopsy on day +19.
Alerting signals, symptoms, evidence of occurrence : 
Both recipients started with respiratory symptoms (dyspnea) and fevre that rapidly evolved to respiratory failure and death.
Demonstration of imputability or root cause: 
Donor was known to be affected with extrapulmonary coccidioidomycosis when he was imprisoned during 5 years. He was treated with amphotericin B followed by fluconazole. Two recipients were diagnosed with the infection. None of the recipients had either been travelling to an endemic area of coccidioidomycosis.
Imputability grade: 
2 Probable
Groups audience: 
Reviewed for imputability grade and expert comment. Reference 648 (this one) i the same as 653. This case is related to liver and kidney transplantation
Suggest new keywords: 
coccidioidomycosis, coccidioides immitis, liver transplantation, kidney transplantation, donor-to-host transmission, respiratory failure,
Adverse occurrence description: 
Coccidioidomycosis donor-to-host transmission
Suggest references: 
Roy M, Park BJ, Chiller TM. Donor-derived fungal infections in transplant patients. Curr Fungal Infect Rep 2010;4:219-28
Expert comments for publication: 
Unfortunately, coccidioidomycosis was not diagnosed as the etiology for death in the donor. And it should have been suspected as the patient had past history of extrapulmonary involvement. By the time the serology from the donor became positive (the availability of the test at the donor center was limited) the transplants were already performed. It is essential to inform as soon as possible the physicians attending the recipients to start with preventive measures.