Two men were left plagued by parasites after receiving an infected kidney transplant at two US hospitals, a new case report reveals.
The two kidneys came from the same organ donor who lived in the Caribbean before his death, according to the report.
The first 61-year-old of the two kidney recipients had undergone transplant surgery at Massachusetts General Hospital (MassGen). Ten weeks after receiving the transplant, he was first admitted to another hospital before being returned to Massgen.
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He had developed nausea, vomiting, excessive thirst, abdominal discomfort, lower back pain and fever. At the first hospital, doctors found fluid buildup in their lungs, and the man started breathing quickly, feeling as if he couldn’t get enough air, and his oxygen levels dropped.
When he entered respiratory failure and shock (which means he had dangerously low blood pressure), he was transferred to Masgen’s intensive care unit, where doctors recorded a purple rash like a bruised constellation, spreading across the skin of his stomach.
The doctor began an extensive investigation into the patient’s medical history and performed a series of tests to determine the cause of his symptoms.
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Patients were taking immunosuppressant medications to prevent the body from rejecting new kidneys, making them more susceptible to infections. The medical team, including Dr. Camille Cotton, an infectious disease and organ transplant expert, had the challenge of cutting down a long list of infectious diseases to find the most likely cause.
Men were given antibiotics and were not improved, allowing them to eliminate bacterial infections. He was also taking the anti-viral and had tested negative for SARS-Cov-2, the virus behind Covid-19. It left some parasite, perhaps the perpetrator. This was supported by the fact that the levels of eosinophils, a type of white blood cell that fights parasitic infections, also spiked the blood of men. These cells could also surge due to drug reactions and graft rejection, but these causes were not considered to be considered to be symptoms in men, Cotton noted.
Cotton had heard of a case in which the transplanted organ had infected the recipient with a small roundworm called stringyloides stercoralis. She contacted New England Donor Services, a local organ procurement organization, about potential contamination. The kidney donor died, but they were able to test the donor’s blood vials. The donor’s blood had strong hairy leaves antibodies. This meant that the donor’s immune system had encountered a worm at some point.
Examination of the patient’s blood samples showed that he had no antibodies to Strongroid prior to implantation, but he did. When the medical team sampled various locations throughout the male body, they discovered that the insects were spreading widely and invading the abdomen, lungs and skin.
Infections from transplants are rare. In more than a decade of US transplants, donor-derived infections affected only 14 of 10,000 organ transplants. US doctors cannot use organs from people with certain active infections such as tuberculosis, and donated organs are tested for infectious diseases, but these tests do not always catch everything.
This review pointed out 13 proven or possible sclerotic infections over the course of a decade, accounting for 42% of all parasite infections transmitted by organ transplantation. Prior to this review, fewer than one in four organ transplant tissues regularly screened Strongyloid, but in 2023, organ procurement and transplant networks sought universal testing for this parasite.
The Massgen Medical team treated men with ivermectin, a powerful antiparacidic drug. They received special permission to administer the medicine directly beneath his skin to combat systemic infections.
Meanwhile, the same deceased donor has been notified to other medical centers where the organ was transplanted. This flagged the 66-year-old man being treated for Albany Medical Center after implant surgery, low white blood cells, and worsening renal function.
Sharing the notes with the Massgen team, the doctor was able to successfully treat this second patient who had received the other kidneys of the donor.
“Organ transplants save lives,” a spokesman for Albany Medical Center told Live Science in an email. “In rare cases like these, communication and coordination between our hospitals is extremely important for the involvement of infectious disease doctors at both hospitals, and as our local organ procurement organization provided us.”
Live Science contacted Massgen for comments.
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