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Case Reports
. 2014 Jan;14(1):163-71.
doi: 10.1111/ajt.12536. Epub 2013 Nov 26.

Risk for transmission of Naegleria fowleri from solid organ transplantation

S L Roy  1 , R Metzger, J G Chen, F R Laham, M Martin, S W Kipper, L E Smith, G M Lyon 3rd, J Haffner, J E Ross, A K Rye, W Johnson, D Bodager, M Friedman, D J Walsh, C Collins, B Inman, B J Davis, T Robinson, C Paddock, S R Zaki, M Kuehnert, A DaSilva, Y Qvarnstrom, R Sriram, G S Visvesvara
Affiliations
Case Reports

Risk for transmission of Naegleria fowleri from solid organ transplantation

S L Roy et al. Am J Transplant. 2014 Jan.

Abstract

Primary amebic meningoencephalitis (PAM) caused by the free-living ameba (FLA) Naegleria fowleri is a rare but rapidly fatal disease of the central nervous system (CNS) affecting predominantly young, previously healthy persons. No effective chemotherapeutic prophylaxis or treatment has been identified. Recently, three transplant-associated clusters of encephalitis caused by another FLA, Balamuthia mandrillaris, have occurred, prompting questions regarding the suitability of extra-CNS solid organ transplantation from donors with PAM. During 1995-2012, 21 transplant recipients of solid organs donated by five patients with fatal cases of PAM were reported in the United States. None of the recipients developed PAM, and several recipients tested negative for N. fowleri by serology. However, historical PAM case reports and animal experiments with N. fowleri, combined with new postmortem findings from four patients with PAM, suggest that extra-CNS dissemination of N. fowleri can occur and might pose a risk for disease transmission via transplantation. The risks of transplantation with an organ possibly harboring N. fowleri should be carefully weighed for each individual recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. In this article, we present a case series and review existing data to inform such risk assessments.

Keywords: Ameba; Naegleria; amoeba; disseminated; primary amebic meningoencephalitis; transplant.

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Conflict of interest statement

Disclosure: The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1. Post-mortem examination of lung, thyroid, heart, and spleen tissue from a 10-year-old male organ donor in Florida (Case #1) who died from primary amebic meningoencephalitis due to Naegleria fowleri in 2009
Naegleria fowleri trophozoites in lung (upper left) and thyroid (upper right) sections by hematoxylin and eosin (H&E) staining at 1000X magnification. Naegleria fowleri trophozoites fluorescing in heart (lower left) and spleen (lower right) sections by indirect immunofluorescence (IIF) at 200X magnification.
See this image and copyright information in PMC

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