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Updated: Mar 29, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
A pseudo-outbreak of disseminated cryptococcal disease after orthotopic heart transplantation
E Kennedy1, J Vanichanan2, I Rajapreyar3,4
1Infection Prevention Department, Memorial Hermann Texas Medical Center, Houston, TX, USA.
Abstract:
Cryptococcal infection is the third most common invasive fungal infection (IFI) among solid-organ transplant (SOT) recipients and is considered an important opportunistic infection due to its significant morbidity and mortality. To determine whether a cluster of cryptococcosis in heart transplant patients was of nosocomial nature, three cases of orthotopic heart transplant recipients with postoperative disseminated cryptococcal infection were investigated and paired with an environmental survey in a tertiary care hospital. The infection prevention department conducted a multidisciplinary investigation, which did not demonstrate any evidence of health care-associated environmental exposure. Moreover, multilocus sequence typing showed that one isolate was unique and the two others, although identical, were not temporally related and belong to the most common type seen in the Southern US. Additionally, all three patients had preexisting abnormalities of the CT chest scan and various degrees of acute and chronic rejection. Reactivation was suggested in all three patients. Screening methods may be useful to identify at risk patients and trigger a prophylactic or preemptive approach. However, more data is needed.
Insights
Cryptococcal infections in heart transplant patients were investigated. Reactivation, not hospital exposure, was the likely cause in these cases, suggesting a need for better screening.
Area of Science:
- Infectious Diseases
- Transplant Surgery
- Mycology
Background:
- Cryptococcal infection is a significant opportunistic infection in solid-organ transplant (SOT) recipients, causing substantial morbidity and mortality.
- It is the third most common invasive fungal infection (IFI) in this vulnerable patient population.
Observation:
- Three cases of orthotopic heart transplant recipients developed disseminated cryptococcal infection postoperatively.
- An investigation, including an environmental survey, was conducted to assess a potential nosocomial outbreak.
- Multilocus sequence typing (MLST) was used to analyze the genetic relatedness of the *Cryptococcus* isolates.
Findings:
- The multidisciplinary investigation found no evidence of health care-associated environmental exposure.
- MLST revealed one unique isolate and two identical isolates that were not temporally related and matched a common type in the Southern US.
- All three patients exhibited preexisting abnormalities on chest CT scans and varying degrees of acute and chronic rejection.
Implications:
- The findings suggest that cryptococcal infection reactivation, rather than nosocomial acquisition, is a likely cause in these heart transplant patients.
- Preexisting lung abnormalities and rejection may predispose SOT recipients to cryptococcal reactivation.
- Screening methods could identify at-risk patients for prophylactic or preemptive treatment, though further data is required.
