Disseminated Mycobacterium tuberculosis from Infected Bone Graft Source : Case Study in Iatrogenic Infection and Our...

Area of Science:

• Infectious Diseases
• Transplantation Immunology
• Public Health

Background:

• Iatrogenic infections from cadaveric bone grafts pose significant risks, as evidenced by two Mycobacterium tuberculosis (Mtb) outbreaks in the US resulting in fatalities.
• Immunocompromised individuals, particularly those with a history of organ transplantation, are highly susceptible to severe outcomes from such infections.

Purpose of the Study:

• To report a case of disseminated Mycobacterium tuberculosis (Mtb) infection in a recipient of a cadaveric bone graft from a 2023 outbreak.
• To investigate the source and spread of Mtb infection linked to a specific cadaveric bone graft.
• To compare this Mtb outbreak with other iatrogenic infection outbreaks and discuss management strategies.

Main Methods:

• Case report of a 57-year-old immunocompromised female patient who received a cadaveric bone graft.
• Clinical presentation analysis including lymphadenopathy and surgical site ulceration.
• Microbiological workup with positive Mtb cultures, autopsy, and histological examination of affected organs.
• Investigation into the bone graft source and identification of similar infections in other recipients.

Main Results:

• The patient developed disseminated Mtb infection, confirmed by autopsy findings including liver and lung granulomas with acid-fast organisms.
• The kidney abscesses were attributed to Candida species, indicating a polymicrobial infection.
• Further investigation revealed similar Mtb infections in other recipients of the same bone graft source, confirming the outbreak's origin.

Conclusions:

• Cadaveric bone grafts can transmit Mycobacterium tuberculosis (Mtb), leading to severe disseminated infections and fatalities, especially in immunocompromised hosts.
• This case underscores the critical need for stringent screening and sterilization protocols for allograft materials.
• Effective management strategies are crucial for addressing iatrogenic infection outbreaks originating from contaminated biological materials.