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Prompt recognition, treatment needed for transplant-transmitted encephalitis | Infectious Disease

Clinicians, pathologists and public health workers must be more aware of the emerging infectious agents that cause transplant-transmitted encephalitis, according to CDC researchers. Prompt recognition and treatment of these difficult-to-diagnose cases is crucial.

“The investigation of infections resulting from organ transplanted-transmitted pathogens requires rapid communication among transplant physicians, organ procurement organizations and public health authorities,” the researchers wrote in Emerging Infectious Diseases. “Prompt notification to public health authorities can enable rapid investigation and discovery of clusters from a common donor. Until active surveillance can be implemented, timely communication and use of traditional and novel diagnostic testing can be crucial in identifying unusual and emerging infections caused by transplant-transmitted pathogens.”

Each year, more than 28,000 transplants are performed in the United States. The risk for transplant-transmitted infection is a global public health issue, according to the researchers.

The CDC studied clusters of encephalitis in transplant recipients from 2002 to 2013. The researchers found that encephalitis was caused by West Nile virus, rabies virus, lymphocytic choriomeningitis virus and Balamuthia mandrillaris amebae.

Identifying and diagnosing transplant-transmitted encephalitis can be challenging. The primary sign of encephalitis — altered mental status — is also common in other systemic processes. Coexisting conditions in the transplant recipient can cloud the issue, too. Geographic distance is also problematic. Linking fever and encephalitis in recipients who live in different geographic areas may be difficult. These issues could result in transplant-transmitted encephalitis cases going unrecognized, according to the researchers.

“Better recognition of encephalitis among organ donors and prompt notification of transplant centers regarding possible transmission are essential to improve clinical management of recipients, including prophylaxis or treatment,” the researchers wrote.

A surveillance system that would identify illness in organ recipients and then notify transplant center physicians, organ procurement organizations and public health authorities may help accelerate the discovery of encephalitis clusters, they said.

In addition, a standardized risk assessment tool, which would gather medical, demographic and social risk factors for encephalitis from organ donors, may reduce pathogen transmission, according to the researchers.

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