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Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis

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ABSTRACT

In April 2014, a kidney transplant recipient in the United States experienced headache, diplopia, and confusion, followed by neurologic decline and death. An investigation to evaluate the possibility of donor-derived infection determined that 3 patients had received 4 organs (kidney, liver, heart/kidney) from the same donor. The liver recipient experienced tremor and gait instability; the heart/kidney and contralateral kidney recipients were hospitalized with encephalitis. None experienced gastrointestinal symptoms. Encephalitozoon cuniculi was detected by tissue PCR in the central nervous system of the deceased kidney recipient and in renal allograft tissue from both kidney recipients. Urine PCR was positive for E. cuniculi in the 2 surviving recipients. Donor serum was positive for E. cuniculi antibodies. E. cuniculi was transmitted to 3 recipients from 1 donor. This rare presentation of disseminated disease resulted in diagnostic delays. Clinicians should consider donor-derived microsporidial infection in organ recipients with unexplained encephalitis, even when gastrointestinal manifestations are absent.

No MeSH data available.


Related in: MedlinePlus

Transmission electron microscopy of microsporidia identified in allograft samples from right kidney recipient. The organism shows cross-sections through the polar tube with up to 6 coils and a unikaryotic nucleus, which is characteristic of Encephalitozoon cuniculi. Scale bar indicates 100 nm.
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Figure 2: Transmission electron microscopy of microsporidia identified in allograft samples from right kidney recipient. The organism shows cross-sections through the polar tube with up to 6 coils and a unikaryotic nucleus, which is characteristic of Encephalitozoon cuniculi. Scale bar indicates 100 nm.

Mentions: Subsequent PCR of DNA extracts from the right renal allograft revealed the species to be E. cuniculi, and electron microscopy showed a polar tubule arrangement characteristic for E. cuniculi (Figure 2). The recipient’s CNS tissue also was positive for E. cuniculi by histopathology and PCR, which showed microsporidia associated with glial nodules and the leptomeninges, the latter with perivascular inflammation. No arteritis or aneurysmal change in the vessels of the CNS were observed. Immunohistochemistry of CNS tissue also provided positive results (Table 2). IHC results were negative for lymphocytic choriomeningitis virus, measles virus, and T. cruzi.


Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis
Transmission electron microscopy of microsporidia identified in allograft samples from right kidney recipient. The organism shows cross-sections through the polar tube with up to 6 coils and a unikaryotic nucleus, which is characteristic of Encephalitozoon cuniculi. Scale bar indicates 100 nm.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5382757&req=5

Figure 2: Transmission electron microscopy of microsporidia identified in allograft samples from right kidney recipient. The organism shows cross-sections through the polar tube with up to 6 coils and a unikaryotic nucleus, which is characteristic of Encephalitozoon cuniculi. Scale bar indicates 100 nm.
Mentions: Subsequent PCR of DNA extracts from the right renal allograft revealed the species to be E. cuniculi, and electron microscopy showed a polar tubule arrangement characteristic for E. cuniculi (Figure 2). The recipient’s CNS tissue also was positive for E. cuniculi by histopathology and PCR, which showed microsporidia associated with glial nodules and the leptomeninges, the latter with perivascular inflammation. No arteritis or aneurysmal change in the vessels of the CNS were observed. Immunohistochemistry of CNS tissue also provided positive results (Table 2). IHC results were negative for lymphocytic choriomeningitis virus, measles virus, and T. cruzi.

View Article: PubMed Central - PubMed

ABSTRACT

In April 2014, a kidney transplant recipient in the United States experienced headache, diplopia, and confusion, followed by neurologic decline and death. An investigation to evaluate the possibility of donor-derived infection determined that 3 patients had received 4 organs (kidney, liver, heart/kidney) from the same donor. The liver recipient experienced tremor and gait instability; the heart/kidney and contralateral kidney recipients were hospitalized with encephalitis. None experienced gastrointestinal symptoms. Encephalitozoon cuniculi was detected by tissue PCR in the central nervous system of the deceased kidney recipient and in renal allograft tissue from both kidney recipients. Urine PCR was positive for E. cuniculi in the 2 surviving recipients. Donor serum was positive for E. cuniculi antibodies. E. cuniculi was transmitted to 3 recipients from 1 donor. This rare presentation of disseminated disease resulted in diagnostic delays. Clinicians should consider donor-derived microsporidial infection in organ recipients with unexplained encephalitis, even when gastrointestinal manifestations are absent.

No MeSH data available.


Related in: MedlinePlus