Donor-derived ehrlichiosis: two clusters following solid organ transplantation

Aditi Saha, Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
Charles J. Browning MD, Lehigh Valley Health NetworkFollow
Raja Dandamudi, Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA.
Kevin Barton, Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA.
Kevin Graepel, Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA.
Madeline Cullity, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Wala Abusalah, Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
Christine W. Du MD, Lehigh Valley Health NetworkFollow
Carla Rossi, Lehigh Valley Health NetworkFollow
Naomi Drexler, Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Sridhar Basavaraju, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pallavi Annambhotia, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Rodrigo Vazquez Guillamet, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Albert J. Eid, Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, Kansas, USA.
Joseph Maliakkal, Division of Pediatric Nephrology, Saint Louis University, Missouri, USA.
Aaron Miller, Division of Pediatric Infectious Disease, Saint Louis University, Missouri, USA.
Christopher Hugge, Division of Pediatric Hematology Oncology, Saint Louis University, Missouri, USA.
Vikas R. Dharnidharka, Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA.
Praveen Kandula, Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
Michael J. Moritz MD, Lehigh Valley Health NetworkFollow

Document Type

Article

Publication Date

7-30-2021

Publication Title

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

E-ISSN

1537-6591

Department(s)

Department of Medicine; Department of Surgery; Fellows and Residents

Keywords

DDI, Ehrlichiosis, HLH, Infection, deceased donor, hemophagocytic lymphocytic histiocytosis, ticks, transplantation

Abstract

Ehrlichiosis has been infrequently described as transmissible through organ transplantation. Two donor derived clusters of ehrlichiosis are described here. During the summer of 2020, two cases of ehrlichiosis were reported to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Disease Control and Prevention (CDC) for investigation. Additional transplant centers were contacted to investigate similar illness in other recipients and samples were sent to CDC. Two kidney recipients from a common donor developed fatal ehrlichiosis-induced hemophagocytic lymphocytic histiocytosis (HLH). Two kidney recipients and a liver recipient from another common donor developed ehrlichiosis. All three were successfully treated. Clinicians should consider donor-derived ehrlichiosis when evaluating recipients with fever early after transplantation after more common causes are ruled out, especially if the donor has epidemiological risk factors for infection. Suspected cases should be reported to the organ procurement organization (OPO) and the OPTN for further investigation by public health authorities.

DOI

10.1093/cid/ciab667

PubMed ID

34329411

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