Transmission of Cryptococcus neoformans by Organ Transplantation

We describe the investigation of Cryptococcus neoformans infection in three recipients of cadaveric organ transplants from one donor with unrecognized cryptococcal meningoencephalitis. This report emphasizes the importance and difficulty of recognizing fungal infection pre-transplant in the donor with an undifferentiated neurologic condition. Evaluation for cryptococcosis in donors with unexplained neurologic symptoms should be considered. Background . This article describes transmission of Cryptococcus neoformans by solid organ transplantation. Methods. We reviewed medical records and performed molecular genotyping of isolates to determine potential for donor transmission of Cryptococcus. Results . Cryptococcosis was diagnosed in 3 recipients of organs from a common donor with an undifferentiated neurologic condition at the time of death. Cryptococcal meningoencephalitis was later diagnosed in the donor at autopsy. The liver and 1 kidney recipient developed cryptococcemia and pneumonia and the other kidney recipient developed cryptococcemia and meningitis; 2 patients recovered with prolonged antifungal therapy. We tested 4 recipient isolates with multilocus sequence typing and found they had identical alleles. Conclusions. Our investigation documents the transmission of Cryptococcus neoformans by organ transplantation. Evaluation for cryptococcosis in donors with unexplained neurologic symptoms should be strongly considered.