Skip Navigation

Transmission of Balamuthia mandrillaris by Organ Transplantation

  1. Matthew J. Kuehnert1
  2. for the Balamuthia Transplant Investigation Teamsb
  1. 1Centers for Disease Control and Prevention, Atlanta, Georgia
  2. 2University of Mississippi Medical Center, Jackson
  3. 3Kentucky Department for Public Health, Frankfort
    1. Correspondence: E. C. Farnon, Philadelphia Department of Public Health, 500 S Broad St, 2nd Flr, Philadelphia, PA 19146 (eileen.farnon{at}phila.gov).
    1. a Deceased.

    2. b The members of the 2009 and 2010 Balamuthia Transplant Investigation Teams are listed in the Notes at the end of the article.

    Abstract

    Background. During 2009 and 2010, 2 clusters of organ transplant–transmitted Balamuthia mandrillaris, a free-living ameba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor.

    Methods. We investigated all recipients and the 2 donors through interview, medical record review, and testing of available specimens retrospectively. Surviving recipients were tested and treated prospectively.

    Results. In the 2009 cluster of illness, 2 kidney recipients were infected and 1 died. The donor had Balamuthia encephalitis confirmed on autopsy. In the 2010 cluster, the liver and kidney-pancreas recipients developed Balamuthia encephalitis and died. The donor had a clinical syndrome consistent with Balamuthia infection and serologic evidence of infection. In both clusters, the 2 asymptomatic recipients were treated expectantly and survived; 1 asymptomatic recipient in each cluster had serologic evidence of exposure that decreased over time. Both donors had been presumptively diagnosed with other neurologic diseases prior to organ procurement.

    Conclusions.Balamuthia can be transmitted through organ transplantation with an observed incubation time of 17–24 days. Clinicians should be aware of Balamuthia as a cause of encephalitis with high rate of fatality, and should notify public health departments and evaluate transplant recipients from donors with signs of possible encephalitis to facilitate early diagnosis and targeted treatment. Organ procurement organizations and transplant centers should be aware of the potential for Balamuthia infection in donors with possible encephalitis and also assess donors carefully for signs of neurologic infection that may have been misdiagnosed as stroke or as noninfectious forms of encephalitis.

    Key words

    • Received January 12, 2016.
    • Accepted June 14, 2016.
    | Table of Contents

    This Article

    1. Clin Infect Dis. 63 (7): 878-888. doi: 10.1093/cid/ciw422
    1. Supplementary Data
    2. All Versions of this Article:
      1. ciw422v1
      2. ciw422v2
      3. 63/7/878 most recent

    Classifications

    Share

    1. Email this article

    Published on behalf of

    cid cover HIV Medicine Association Logo

    Society Members: For your free access to this journal, log in via the IDSA members area.

    Impact Factor: 8.886

    5-Yr impact factor: 9.206

    For Reviewers

    Looking for your next opportunity?

    Looking for jobs...

    For the Media

    Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.