Donor-derived Ehrlichiosis: 2 Clusters Following Solid Organ Transplantation

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Public Health

Background:

• Ehrlichiosis is rarely transmitted via organ transplantation.
• Donor-derived infections pose a significant risk to transplant recipients.
• Prompt identification of Ehrlichia infection is critical in post-transplant care.

Purpose of the Study:

• To describe two distinct clusters of donor-derived ehrlichiosis cases.
• To highlight the potential for severe outcomes, including hemophagocytic lymphohistiocytosis.
• To emphasize the importance of clinical suspicion and reporting.

Main Methods:

• Case investigation initiated by the Organ Procurement and Transplantation Network (OPTN) and Centers for Disease Control and Prevention (CDC).
• Contacting additional transplant centers to identify similar cases.
• Laboratory sample analysis at the CDC.

Main Results:

• Two cases of fatal ehrlichiosis-induced hemophagocytic lymphohistiocytosis in kidney recipients from a single donor.
• Three cases of ehrlichiosis in kidney and liver recipients from a second donor, all successfully treated.
• Demonstrated transmission of Ehrlichia through organ donation.

Conclusions:

• Clinicians must consider donor-derived ehrlichiosis in recipients presenting with fever post-transplantation, especially after excluding common causes.
• Epidemiological risk factors in donors should prompt heightened suspicion.
• Reporting suspected cases to organ procurement organizations and the OPTN is vital for public health investigation.