Adverse Occurrence type:
MPHO Type:
Estimates Frequency:
In this case there is a possible transmission from a donor of four organs (heart, liver and kidneys) to one of the recipients (one of the kidneys)
Time to detection:
Eight weeks
Alerting signals, symptoms, evidence of occurrence :
The recipient presented with fever, prostration and, finally, seizures.
Demonstration of imputability or root cause:
The possibility of transmission is based in the lack of a history of travel to an endemic area of the recipient. However, travel history from the donor is lacking. Serology (test for screening) for coccidioidomycosis was not performed as both donor and recipient were from Portugal and none of them travelled o resided in an endemic area. Moreover, it was only one of the kidney recipients that resulted infected. The other 3 recipients (kidney, live and heart) did not develop the infection. In fact, serology for coccidioidomycosis tested negative (only once) in the heart recipient.
Imputability grade:
1 Possible
Groups audience:
Note:
I am revising all references linked to coccidioidomycosis to determine if all of them can be merged in just one. By the way, in this case, there was some data lacking (imputability, expert comment, keywords)
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:
Coccidioidomycosis is an endemic infection. Travel history is of paramount importance to determine who must be tested with serology for infection. It is really difficult to distinguish reactivation from "de novo" infection in the transplant setting, specially, in endemic areas.