Bartonella quintana Infection in Kidney Transplant Recipients from Donor Experiencing Homelessness, United States, 2022

Abstract

Bartonella quintana infection can cause severe disease that includes clinical manifestations such as endocarditis, chronic bacteremia, and vasoproliferative lesions of the skin and viscera. B. quintana bacteria is transmitted by the human body louse (Pediculus humanus corporis) and is associated with homelessness and limited access to hygienic services. We report B. quintana infection in 2 kidney transplant recipients in the United States from an organ donor who was experiencing homelessness. One infection manifested atypically, and the other was minimally symptomatic; with rapid detection, both recipients received timely treatment and recovered. B. quintana was identified retrospectively in an archived donor hematoma specimen, confirming the transmission link. Information about the organ donor's housing status was critical to this investigation. Evaluation for B. quintana infection should be considered for solid organ transplant recipients who receive organs from donors with a history of homelessness or of body lice infestation.

Keywords: Bartonella quintana; United States; bacteria; homelessness; transplant.

Figure 1

Imaging of a kidney transplant recipient with a Bartonella quintana infection linked to a donor who experienced homelessness, United States, 2022. A) Multiple enhancing T2 hyperintense lesions throughout the hepatic parenchyma. B) Numerous enhancing T2 hyperintense lesions affecting cervical, thoracic, and lumbar vertebrae.

Figure 2

Liver biopsy of a kidney transplant recipient with a Bartonella quintana infection linked to a donor who experienced homelessness, United States, 2022. A) Fibrovascular proliferation accompanied by few inflammatory cells. Magnification ×200. B) Myxoid stroma that contains clumps of granular material (arrows). Magnification ×400. C) Warthin-Starry stain highlights clumps of bacilli (arrows). Magnification ×400.