Status:
Ready to upload
Record number:
2001
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Donor-related filamentous fungal infections are very uncommon
Time to detection:
1 day
Alerting signals, symptoms, evidence of occurrence:
On day 1 after surgery, a filamentous fungus started to grow in the culture plate of the donors’ respiratory sample (BAL), later identified as Aspergillus fumigatus. With this information, analysis of the previous renal biopsies reassessed with specific fungal stains (calcofluor white) revealed filamentous fungi, which were subsequently confirmed by the histopathologist. Despite the fact that both recipients were in a stable clinical situation and given the potential presence of invasive aspergillosis, elective nephrectomy was performed on day +3 after transplant in both cases.
Demonstration of imputability or root cause:
Both renal grafts came from a 50-year-old man with a history of alcoholic cirrhosis, death after 5 days in ICU attributed to a cerebral hemorrhage resulting from severe liver failure with massive bronchoaspiration. In both cases, A. fumigatus was isolated in post nephrectomy samples from the cortex and vascular sutures. Tissue invasion was confirmed, and real-time PCR was positive for Aspergillus spp. Imputability was clearly demonstrated by means of determination of genotype. All three samples from donor (BAL sample) and both recipients (renal biopsies) were identical in the allele composition for 9 markers.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
aspergillosis, beta-D-glucan, invasive fungal infection
Reference attachment:
Suggest references:
Valerio M, et al. Donor-derived invasive aspergillosis after kidney transplant.Med Mycol Case Rep. 2018 Jul 17;22:24-26
Note:
See also records n.370, 372,374,990 (EP)
Expert comments for publication:
Although very uncommon, aggressive diagnostic procedures should be done if there is suspicion of donor fungal infection based in the basal clinical condition and clinical symptoms such as intracerebral hemorrhage or pulmonary nodules. The potential risk of invasive aspergillosis transmission to recipients could be suspected in donors with risk factors for invasive fungal infections such as treatment with broad-spectrum antibiotics and corticosteroids and in bad medical condition such as hepatic cirrhosis or severe lung obstructive pulmonary disease. On the other hand, very sensitive albeit non specific tests are available when suspecting invasive fugal disease such as determination of Beta-D-glucan in serum.