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Organ Transplantation


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Organ transplantation from donors infected by Naegleria fowleri has occurred on at least five occasions in the U.S. and none of the organ recipients became infected 1, 2, 3. However, although transmission via organ transplantation has not been documented for Naegleria fowleri, three clusters of transplant associated Balamuthia mandrillaris infection, another type of free-living ameba, have been reported to CDC 4, 5. In addition, there are limited data from animal studies 6–9 and historical case reports 10-14 suggesting that hematogenous spread of Naegleria amebae to extra-CNS organs might be possible, particularly late in the clinical course of PAM when tissue destruction is greatest and the blood-brain barrier is compromised. Further, the CDC Free-Living Ameba Laboratory has recently observed Naegleria fowleri in tissue sections of lung, kidney, heart, spleen, and thyroid from two deceased PAM cases, although tissue cross-contamination during autopsy cannot be ruled out. As a result, although the risk of transmission of Naegleria fowleri by donor organs is still unknown, it is unlikely to be zero and therefore warrants continued study of the benefits and risks of transplanting organs or tissues from people infected by Naegleria fowleri.

References
  1. Kramer MH, Lerner CJ, Visvesvara GS. Kidney and liver transplants from a donor infected with Naegleria fowleri. J Clin Microbiol. 1997;35(4):1032-3.
  2. Bennett WM, Nespral JF, Rosson MW, McEvoy KM. Use of organs for transplantation from a donor with primary meningoencephalitis due to Naegleria fowleri. Am J Transplant. 2008;8:1334-5.
  3. Tuppeny M. Primary amoebic meningoencephalitis with subsequent organ procurement: a case study. J Neurosci Nurs. 2011;43:274-9.
  4. CDC. Balamuthia mandrillaris transmitted through organ transplantation—Mississippi, 2009. MMWR Morb Mortal Wkly Rep. 2010;59:1165-70.
  5. CDC. Notes from the field: Transplant-transmitted Balamuthia mandrillaris—Arizona, 2010. MMWR Morb Mortal Wkly Rep. 2010;59(36):1182.
  6. Carter RF. Description of a Naegleria sp. isolated from two cases of primary amoebic meningoencephalitis, and of the experimental pathological changes induced by it. J Pathol 1970;100:217–44.
  7. Jaroli KL, McCosh JK, Howard MJ. The role of blood vessels and lungs in the dissemination of Naegleria fowleri following intranasal inoculation in mice. Folia Parasitol 2002;49:183–8.
  8. Simeon EC, Natividad FF, Enriquez GL. The pathogenicity of a Philippine isolate of Naegleria sp. in mice: effects of dose levels and routes of infection. Southeast Asian J Trop Med Public Health 1990;21:598–606.
  9. Willaert E, Stevens AR. Experimental pneumonitis induced by Naegleria fowleri in mice. Trans R Soc Trop Med Hyg 1980;74:779–83.
  10. Derrick EH. A fatal case of generalized amoebiasis due to a protozoon closely resembling, if not identical with, Iodamoeba butschlii. Trans R Soc Trop Med Hyg 1948;42:191–8.
  11. Culbertson CG. The pathogenicity of soil amebas. Annu Rev Microbiol 1971;25:231–54.
  12. McMillan B. Diagnostic review of Derrick’s case of generalized amoebiasis (Iodamoeba butschlii). Pathology 1977;9:76.
  13. Duma RJ, Ferrell HW, Nelson EC, Jones MM. Primary amebic meningoencephalitis. N Engl J Med 1969;281:1315–23.
  14. Duma RJ. Primary amoebic meningoencephalitis. CRC Crit Rev Clin Lab Sci 1972;3:163–92.

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  • Page last reviewed: November 14, 2013
  • Page last updated: November 14, 2013
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