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Adverse Occurrence type:
Prior to this report, two other events of possible donor-derived transmission of mold infections involving scedosporiosis have been published.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
The donor was a victim of near-drowning and has bilateral lobar consolidation, fever and elevated white blood cell count. Sputum, urine and blood cultures were reported as negative. Three organ recipients (heart, two kidneys) developed fatal scedosporiosis following transplantation of organs from the same deceased nearly-drowned donor; two other recipients (split liver) who received prophylactic voriconazole did not develop any subsequent signs of infection. On post-transplant day 7, the heart transplant recipient presented with high white cell blood count (40,380 cells/mm3), intra-cerebral haemorrhage and seizures. Scedosporium spp. was isolated from blood cultures on day +11. Renal recipient 1 developed altered mental status on post-operative day 23, pulmonary consolidation and pleural effusion, and died on day +36. Renal recipient 2 developed generalised weakness 4 weeks post-transplant, skin abscess in the area overlaying the graft site, and endophthalmitis; the patient died on day 58. Cultures form various sites were positive for Scedosporium spp. The liver recipient received liposomal amphotericin B 1 mg/kg/day between post-transplant day (PT) 1 and 8 as per routine protocol; following diagnosis in the other recipients, oral voriconazole 8 mg/kg/day was given from PT 42 and switched to fluconazole 400mg po qd from PT 80 to PT 220. He was followed until PT 340 without any sign of infection. The second liver recipient (pediatric patient, split liver) received itraconazole prophylaxis for 4 weeks, according to the centre protocol; this was changed to Voriconazole until PT 188 and she was followed to PT 350, without any sign of infection.
Demonstration of imputability or root cause:
Genotypically indistinguishable strains of Scedosporium aurantiacum were recovered from the the heart and the two kidney recipients. The two other recipients (split liver) who received prophylactic voriconazole did not develop any subsequent signs of infection: IWDT (intervention without documented transmission).
Suggest new keywords:
fungal donor-derived infection, scedosporium apiospermum, kidney transplantation, heart transplantation
Kim SH, Ha YE, Youn JC, Park JS, Sung H, Kim MN, et al. Fatal Scedosporiosis in Multiple Solid Organ Allografts Transmitted From a Nearly-Drowned Donor. American journal of transplantation 2015, 29 January (online)
Case involving three organ recipients (heart, left kidney, right kidney) who developed fatal scedosporiosis following deceased donor transplantation from the same nearly-drowned donor, together with the survival of two other recipients (two split liver recipients, IWDT) who received prophylactic antifungal therapy. We have to consider three different DDI: heart and two kidneys. Add scedosporium to the fungal taxonomy, clone record for kidney and liver (Evi).
Expert comments for publication:
Although presence of the microorganism was not demostrated in the donor, Scedosporium is the commonest mold associated with pneumonia resulting from near-drowning. Three recipients from a common donor died of complications of invasive Scedosporium infection, and the isolates were shown to be genetically indistinguishable.