Influenza A virus

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Rarely reported
Time to detection: 
3 days
Alerting signals, symptoms, evidence of occurrence: 
A 39-year-old male patient who had received current seasonal influenza vaccination underwent bilateral lung transplantation. Recipient was diagnosed with pericarditis within 24 hours from transplant but this was attributed to a post surgical complication and not of infectious origin. Influena A virus was isolated from a routine BAL taken on day +3. Recipient did not develop any additional signs of influenza illness and his clinical picture did not change; he was treated with Oseltamivir for 5 days and remained well.
Demonstration of imputability or root cause: 
Recipient's immediate pre-transplant bronchial sample was negative by viral culture. Donor had pulmonary right basal infiltrates on chest X ray and their bronchoalveolar lavage (BAL) was positive for Influenza A by polymerase chain reaction (PCR). A routine BAL from the recipient, taken on day +3 yielded a positive result for Influenza A virus by virus culture, confirmed by immunofluorescense. Events are compatible with donor-derived transmission but this was not unequivocally proven.
Imputability grade: 
2 Probable
Suggest new keywords: 
Influenza A virus, influenza, seasonal influenza, influenza vaccine, Oseltamivir, bronchoalveolar lavage, immunofluorescence, PCR, viral culture, pulmonary infiltrates
Suggest references: 
- Influenza B virus transmission in recipients of kidney and lung transplants from an infected donor - Influenza transmission to recipient through lung transplantation
Expert comments for publication: 
Influenza immunisation and prompt anti-viral treatment are likely to have influenced positive outcome. The authors refer to this case as an example that lungs from donors with influenza can be accepted for transplantation. It must be emphasised however that influenza illness has a whole spectrum of manifestation and given the risk of lower tract complications, case by case, careful risk assessment is required when influenza infection in the donor is known. Both donor and recipient can have interventions to minimise risk of complications in the recipient. Other organs are deemed generally safe for transplantation, given the absence of viraemia in seasonal influenza infection. Vaccination of patiets in the transplant waiting list remain an important prophylactic measure. It must be emphasised that these notes refer to seasonal influenza only and not to pandemic or avian influenza.