Record number:
1056
Adverse Occurrence type:
MPHO Type:
Time to detection:
3 days
Alerting signals, symptoms, evidence of occurrence:
AML patient received PBSC from allogeneic, fully matched donor. Donor travelled to Sri Lanka and returned to Germany 3 days before starting on G-CSF; donor deferral would have applied but she was the only match for a recipient who was in urgent need of SCT. On day +3, the recipient developed fever, hepatomegaly, hyperbilirrubinemia and was diagnosed with veno-occlusive disease. Diagnosis of bacterial infection with S. epidermidis and Acinetobacter baumannii was made. Patient developed severe abdominal pain, hematochezia, metabolic acidosis and dies on day +9 due to enterocolitis and veno-occlusive disease. Sample taken on day +3 was retrospectively tested and shown to be negative for dengue IgM and IgG, but positive for RNA at 8.6 E+07 copies/ml. The authors do not believe dengue was a contributor to the death of the recipient.
Demonstration of imputability or root cause:
On day of apheresis, donor had fever, bone pain and headache, and a platelet count of 134,000 cells/ml, which fell to 47,000. High fever and a mild skin rash ensued. Diagnosis was made on day +3 in the donor, with positive NS1Ag , IgM and IgG, dengue RNA in blood at 2.6 E+10 copies/ml. Sequencing of donor and recipient viruses revealed DENV serotype 1, genotype 1; complete ENV sequence revelead donor strain to be highly related to circulating virus in Sri Lanka. Authors do not disclose sequence homology between donor and recipient.
Imputability grade:
3 Definite/Certain/Proven
Keywords:
References:
Suggest references:
Punzel M, Korukluoglu G, Caglayik DY, Menemenlioglu D, Bozdag SC, Tekgunduz E, et al. Dengue virus transmission by blood stem cell donor after travel to Sri Lanka; Germany, 2013. Emerg Infect Dis. 2014;20(8):1366-9.