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Donor-Derived Bartonella quintana Infection in Solid Organ Transplantation: An Emerging Public Health Issue With
Carl Boodman1,2, Oscar Fernandez Garcia3, Dima Kabbani3
1Division of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract:
Bartonella quintana is a louse-borne intracellular bacterium that remains a neglected cause of bacteremia, bacillary angiomatosis, and infective endocarditis among individuals experiencing poverty. In October 2023, Health Canada notified Canadian organ transplantation programs of an outbreak of donor-derived B quintana infection. From March to August 2023, 5 cases of donor-derived B quintana disease were acquired in Alberta, Canada, from 3 deceased donors who had experienced homelessness. Similar cases recently occurred in the United States. In this article, we discuss strategies to screen organ donors and monitor transplant recipients for B quintana infection using epidemiologic risk factors, physical examination signs, and laboratory diagnostic tests. We review the limitations of existing diagnostic tests for B quintana and describe how these problems may be magnified in the organ transplantation context.
Insights
Bartonella quintana, a louse-borne bacterium, caused an outbreak of infection in Canadian organ transplant recipients from infected donors. Strategies are needed to screen donors and monitor recipients for this neglected disease.
Area of Science:
- Infectious Diseases
- Bacteriology
- Transplant Medicine
Background:
- Bartonella quintana is a neglected louse-borne bacterium causing serious infections.
- It is associated with poverty and can lead to bacteremia, bacillary angiomatosis, and endocarditis.
- An outbreak of donor-derived B. quintana infection occurred in Canadian organ transplant programs in 2023.
Purpose of the Study:
- To discuss strategies for screening organ donors for B. quintana infection.
- To outline methods for monitoring transplant recipients for B. quintana.
- To review diagnostic limitations in the context of organ transplantation.
Main Methods:
- Review of epidemiologic risk factors for B. quintana.
- Assessment of physical examination signs associated with B. quintana.
- Evaluation of laboratory diagnostic tests for B. quintana.
Main Results:
- Five cases of donor-derived B. quintana disease were identified in Alberta, Canada, from March to August 2023.
- The infections were linked to three deceased organ donors who had experienced homelessness.
- Similar cases have recently been reported in the United States.
Conclusions:
- Effective screening of organ donors and monitoring of transplant recipients are crucial to prevent B. quintana transmission.
- Existing diagnostic tests for B. quintana have limitations that may be exacerbated in organ transplantation.
- Further research is needed to improve diagnostic accuracy and screening protocols for B. quintana in transplant settings.
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