Adverse Occurrence type:
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Rapidly fatal, disseminated coccidiomycosis developed after organ transplantation in a liver (recipient # 1) and a kidney recipient (recipient #2) but not the other kidney recipient who received pre-emptive anti-fungal therapy. Recipient #1: on day 13 after liver transplant, a 46 yr old man developed fever, sepsis syndrome, respiratory failure, altered mental status, hypotension. On day 16 bronchial washings showed negative exam but later cultures grew Coccidioides immitis. On day 17 he died and autopsy showed disseminated microabscesses with Coccidioides immitis in the marrow, lungs, kidney, heart, thyroid, pancreas, brain, liver, spleen. No pretransplant test for Coccidioides immitis antibodies. This shows the importance of rapid reporting of infections in organ recipients so that unaffected organ recipients from the same donor can be evaluated and given prophylactic treatment.
Demonstration of imputability or root cause:
Level 4. Certain, Proven transmission. Serious infection, same organism in donor (active at donation) and more than one organ recipient. The recipients had never lived in or visited an endemic area. Donor was young man with headache, malaise, back pain, near-syncope who had cardiac arrest in emergency room and days later became an organ donor. A thorough medical history of the donor was not obtained before donation, but it was noted that he had a remote history of treated coccidiomycosis. After recipients were treated for coccidiomycosis, added information was discovered about the donor: in prison 5 years, released one year before death and 5 years before death he had coccidiomycosis of the skin, vertebral bodies, and sternum with prolonged hospitalization and multiple surgical procedures and lifelong antifungal medicine recommended to him. The brain autopsy report was available one month after transplant, showing the donor had Coccidioides immitis infection in the brain.