Organ Transplantation

Transmission of Balamuthia infection has occurred via organ transplantation from infected donors on three documented occasions ^1–3. Clinicians should consider Balamuthia as a cause of encephalitis in transplant recipients, particularly in those recipients who received organs from a donor who died from a neurologic or unknown cause of death. Transplant centers and organ procurement organizations should be aware of the potential for Balamuthia infection in donors with encephalitis of uncertain etiology.

To date, among three transplant clusters, symptomatic organ recipients have received chemotherapy for treatment of transplant-transmitted granulomatous amebic encephalitis and asymptomatic organ recipients have received prophylactic chemotherapy, guided by serology, for presumed Balamuthia mandrillaris exposure. In the latter scenario, asymptomatic organ recipients in the 2011–2012 cluster were considered exposed and received chemotherapy if their antibody titer reached ≥1:64 and continued therapy, adjusted for side effects, until their titer fell to 1:16 or lower ³. Although the serological treatment points were experimental and require further confirmation and optimal preemptive therapy regimens are undefined, asymptomatic organ recipients in these three clusters who had initial titers ≥1:64 and who were managed in this way did not develop granulomatous amebic encephalitis.

References

1. CDC. Balamuthia mandrillaris transmitted through organ transplantation — Mississippi, 2009. MMWR Morb Mortal Wkly Rep. 2010;59:1165–70.
2. CDC. Notes from the Field: Transplant-transmitted Balamuthia mandrillaris — Arizona, 2010. MMWR Morb Mortal Wkly Rep. 2010;59:1182.
3. Gupte AA, Hocevar SN, Lea AS, Kulkarni RD, Schain DC, Casey MJ, Zendejas-Ruiz IR, Chung WK, Mbaeyi C, Roy SL, Visvesvara GS, da Silva AJ, Tallaj J, Eckhoff D, Baddley JW. Transmission of Balamuthia mandrillaris through solid organ transplantation: utility of organ recipient serology for guide clinical management. Am J Transplant. 2014;14:1417–24.