Severe life-threatening Ehrlichia chaffeensis infections transmitted through solid organ transplantation

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Tick-borne Illnesses

Background:

• Donor-derived infections during organ transplantation are rare due to screening.
• Ehrlichia chaffeensis transmission via organ transplant has not been previously documented.
• This study reports two cases of severe E. chaffeensis infection in renal allograft recipients from a single donor.

Observation:

• Two renal transplant recipients developed severe, acute febrile illness approximately three weeks post-transplant.
• Infectious workup confirmed E. chaffeensis infection in both recipients.
• One recipient had E. chaffeensis DNA detected via PCR, while the other showed positive antibody titers.

Findings:

• Both patients were successfully treated with antibiotics (doxycycline and tigecycline).
• Delayed diagnosis and non-tetracycline antibiotic use were associated with poor outcomes.
• E. chaffeensis can cause significant morbidity and mortality in transplant recipients.

Implications:

• Tick-borne pathogens like E. chaffeensis can be transmitted through organ transplantation.
• Screening protocols for organ donors in endemic areas should include questions about tick exposure.
• Prompt diagnosis and targeted antibiotic therapy are essential for managing E. chaffeensis in transplant recipients.