Record number:
538
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Rare
Time to detection:
5 days
Alerting signals, symptoms, evidence of occurrence:
A 16 year old female received a living-related kidney transplant (mother was donor) in Thailand. On postoperative day 5: low grade fever for a few days, then became afebrile. While afebrile on postoperative day 14 she developed capillary leak syndrome (watery diarrhea, ascites, bilateral pleaural effusions, low albumin, hemoconcentrated) with thrombocytopenia (platelets count 11,000). Blood test showed dengue NS1 Ag and dengue virus serotype 1. By day 28 she developed hemophagocytic syndrome, hypovolemia, hypotension. Her infection resolved and kidney function was normal.
Demonstration of imputability or root cause:
Level 2. Possible. Kidney donor had recent infection but one month before donation (may have cleared viremia by then). Both recipient and donor may have had common source.
Imputability grade:
1 Possible
Groups audience:
Keywords:
Suggest references:
Tangnararatchakit, K.; Tirapanich, W.; Tapaneya-Olarn, W.; Sumethkul, V.; Sirachainan, N.; Watcharananan, S.; Leenanupunth, C.; Yoksan, S.; Chuansumrit, A. Severe nonfebrile dengue infection in an adolescent after postoperative kidney transplantation: a case report. 2012; 44 (1)
Expert comments for publication:
Despite the common occurrence of dengue infection, there have been very few case reports on donor-derived transmission. Due to paucity of data and the fact that these cases have been described in endemic areas, imputability has been “probable” at most. Different to the rare cases of fatal complications of dengue infection acquired in the post transplantation period (not donor-related), the 4 existing publications report good outcome in the recipients. Insufficient data exist about potential virus compartmentalisation after disappearance in blood and dengue outcomes in immunosuppressed individuals. In non-endemic areas, individual risk assessment is the option of choice when exposure to dengue or other relevant arbovruses is identified.