TB spread from donor to recipient needs fast action

NEW YORK (Reuters Health) - The transmission of tuberculosis from a donor organ to a transplant recipient may result in spread of the bacteria outside of the lungs, leading to a wide-spread infection, which may result in unusual symptoms that can make diagnosis difficult. Early recognition of the infection is "critical, as demonstrated by three cases described in the Morbidity and Mortality Weekly Report.

Dr. V. Kohli, at Integris Baptist Medical Center in Oklahoma City, and colleagues report that a 46-year-old organ donor had been hospitalized three times in the 6 months before his death in early June 2007 for presumed aspiration pneumonia

He had a history of alcoholism, homeless, and incarceration, but tuberculin skin tests were negative. Three weeks after his death, a culture from the fluid in his spine grew Mycobacterium tuberculosis, the bacterium that causes TB.

The three recipients of the donor's kidneys and liver were not notified until late July, when they were started on anti-TB therapy.

A 50-year-old recipient of one of the kidneys developed pancytopenia, a depletion of the body's primary blood cells - red blood cells, white blood cells and platelets. The primary functions of these cells are to transport oxygen, fight infection and clot the blood, respectively.

Other symptoms included fever and, 6 weeks after the transplantation, the patient developed a sepsis-like syndrome, a serious, often fatal immune response, leading to her death 3 weeks later.

A 23-year-old woman who received the other kidney developed fever, severe headache and pancytopenia 7 weeks later. She fully recovered after starting anti-TB medications.

The liver recipient, a 59-year-old man, never developed TB.

Examination of the genes in the TB strains isolated from the donor and recipient were identical, Kohli's group reports.