Organ Transplantation

Organ transplantation from donors infected by Naegleria fowleri has occurred on at least five occasions in the U.S. and none of the organ recipients became infected ^1-3. However, although transmission via organ transplantation has not been documented for Naegleria fowleri, three clusters of transplant associated Balamuthia mandrillaris infection, another type of free-living ameba, have been reported to CDC ^4-6. In addition, there are limited data from animal studies ^7-10 and historical case reports ^11-15 suggesting that hematogenous spread of Naegleria amebae to extra-CNS organs might be possible, particularly late in the clinical course of PAM when tissue destruction is greatest and the blood-brain barrier is compromised. Further, the CDC Free-Living Ameba Laboratory has recently observed Naegleria fowleri in tissue sections of lung, kidney, heart, spleen, and thyroid from two deceased PAM cases, although tissue cross-contamination during autopsy cannot be ruled out ¹⁶. As a result, although the risk of transmission of Naegleria fowleri by donor organs is still unknown, it is unlikely to be zero so the risks of transplantation with an organ possibly harboring Naegleria fowleri should be carefully weighed for each individual organ recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. This warrants continued study of the benefits and risks of transplanting organs or tissues from people infected by Naegleria fowleri ¹⁶.

References

1. Kramer MH, Lerner CJ, Visvesvara GS. Kidney and liver transplants from a donor infected with Naegleria fowleri. J Clin Microbiol. 1997;35(4):1032-3.
2. Bennett WM, Nespral JF, Rosson MW, McEvoy KM. Use of organs for transplantation from a donor with primary meningoencephalitis due to Naegleria fowleri. Am J Transplant. 2008;8:1334-5.
3. Tuppeny M. Primary amoebic meningoencephalitis with subsequent organ procurement: a case study. J Neurosci Nurs. 2011;43(5):274-9.
4. CDC. Balamuthia mandrillaris transmitted through organ transplantation—Mississippi, 2009. MMWR Morb Mortal Wkly Rep. 2010;59(36):1165-70.
5. CDC. Notes from the field: Transplant-transmitted Balamuthia mandrillaris—Arizona, 2010. MMWR Morb Mortal Wkly Rep. 2010;59(36):1182.
6. 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(6):1417–24.
7. Carter RF. Description of a Naegleria sp. isolated from two cases of primary amoebic meningoencephalitis, and of the experimental pathological changes induced by it. J Pathol 1970;100:217–44.
8. Jaroli KL, McCosh JK, Howard MJ. The role of blood vessels and lungs in the dissemination of Naegleria fowleri following intranasal inoculation in mice. Folia Parasitol 2002;49(3):183–8.
9. Simeon EC, Natividad FF, Enriquez GL. The pathogenicity of a Philippine isolate of Naegleria sp. in mice: effects of dose levels and routes of infection. Southeast Asian J Trop Med Public Health 1990;21(4):598–606.
10. Willaert E, Stevens AR. Experimental pneumonitis induced by Naegleria fowleri in mice. Trans R Soc Trop Med Hyg 1980;74(6):779–83.
11. Derrick EH. A fatal case of generalized amoebiasis due to a protozoon closely resembling, if not identical with, Iodamoeba butschlii. Trans R Soc Trop Med Hyg 1948;42:191–8.
12. Culbertson CG. The pathogenicity of soil amebas. Annu Rev Microbiol 1971;25:231–54.
13. McMillan B. Diagnostic review of Derrick’s case of generalized amoebiasis (Iodamoeba butschlii). Pathology 1977;9:76.
14. Duma RJ, Ferrell HW, Nelson EC, Jones MM. Primary amebic meningoencephalitis. N Engl J Med 1969;281:1315–23.
15. Duma RJ. Primary amoebic meningoencephalitis. CRC Crit Rev Clin Lab Sci 1972;3:163–92.
16. Roy SL, Metzger R, Chen JG, Laham FR, Martin M, Kipper SW, Smith LE, Lyon GM 3rd, Haffner J, Ross JE, Rye AK, Johnson W, Bodager D, Friedman M, Walsh DJ, Collins C, Inman B, Davis BJ, Robinson T, Paddock C, Zaki SR, Kuehnert M, DaSilva A, Qvarnstrom Y, Sriram R, Visvesvara GS. Risk for transmission of Naegleria fowleri from solid organ transplantation. Am J Transplant. 2014 Jan;14(1):163-71.