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Adverse Occurrence type:
First human to human transmission reported. The cluster described represents (including the donor) the 5th, 6th and 7th recorded cases of deaths caused by the nematode Halicephalobus sp.
Time to detection:
10 - 11 days
Alerting signals, symptoms, evidence of occurrence:
Confusion, abnormal behavior, unsteady gait, fever.
Demonstration of imputability or root cause:
Two male recipients died of rapidly progressive meningoencephalitis 17 to 19 days after receiving kidney transplants from a common donor, a male patient who had died of meningoencephalitis of unknown cause. The donor was admitted with history of fever, tiredness and unsteady gait. Following hospital admission, he developed hydrocephalus, had a CSF with raised protein and moderately elevated white cell count with predominance of lymphocytes. Clinical course in the two kidney recipients (no other organs or tissues transplanted) was nearly identical, and rapidly progressive. Post mortem was not carried out in the donor but it was performed in the 2 recipients, revealing presence of nematode larvae in brain tissue. Morphological and molecular characterization of the larvae led to the identification of Hydrocephalus gingivalis.
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The organ procurement sort cautionary tales report of the incident can be accessed through the link below: http://www.odt.nhs.uk/odt/governance-and-quality/reports-on-incidents/
Add Harm to a recipient/Infection/Parasitic/Halicephalobus in the adverse occurrence taxonomy.
Expert comments for publication:
Details have been extracted from a NHSBT (UK organ procurement agency) report which is available through its website. Detailed description and discussion of the investigation may become available, pending peer-reviewed publication. A set of unusual circumstances in the donor's life style is likely to have facilitated exposure to a nematode which is usually found in the environment. Meningoencephalitis of suspected infectious aetiology as a cause of death poses difficult challenges when considering suitability for organ donation. In the absence of a definitive diagnosis and specific treatment of the donor prior to donation, these donors are largely considered very high risk. Cases should be discussed at the earliest opportunity with appropriate specialists and decision on acceptability should always be taken in consultation with other colleagues.