¿Ves algo que mejorar? Propón un cambio.
Legionnaires' disease is a severe pneumonia caused by Legionella bacteria, which live naturally in fresh water and grow best at 77°F–113°F (25°C–45°C). People usually catch it by inhaling water droplets, though aspiration is also a known route, and infections after near-drowning have been documented. Organ transplant recipients are at higher risk, likely because of the drugs that suppress their immune systems — but transmission through a transplanted organ itself had never been reported.
Two cases, one donor
In 2022, the Pennsylvania Department of Health received reports of two lab-confirmed cases of Legionnaires' disease in patients of the same Philadelphia hospital. Both had each received one lung from the same donor before falling ill. The hospital notified the Organ Procurement and Transplantation Network, whose Disease Transmission Advisory Committee — with CDC leading — investigated.
| Details | |
|---|---|
| Donor | A man aged 30–39 who fell into a river and was underwater for 5 minutes or more. Despite resuscitation, brain injury from lack of oxygen led to brain death. Organs were recovered within 7 days. No one suspected Legionella, and no donor specimens were tested |
| Patient A | A woman aged 70–79 who received the right lung in May 2022. On day 9, high white blood cell counts and sudden anemia prompted a CT scan, which showed dense consolidation in the donor lung that became a cavity over the following week. She was infected with a Legionella species other than L. pneumophila |
| Patient B | A man aged 60–69 who received the left lung the same day. He had many complications, needing ECMO and dialysis, and started the antibiotic doxycycline on day 15. A CT on day 24 showed hazy opacities in the donor lung, and a sputum sample in early June grew L. pneumophila. He recovered at first but, after a long hospital stay, died about 6 months after surgery of respiratory failure from a mucus plug |
Chest CT scans of patient A, infected with a Legionella species other than L. pneumophila after receiving the right lung. From CDC's MMWR.
The donor's heart, liver and right kidney went to three other recipients. None showed signs of legionellosis; only the liver recipient was tested, with a negative urine antigen test.
Ruling out the hospital
- Water records for May–June 2022 — from the drinking-water system and several cooling towers — showed a well-run water management program, with disinfectant at every tested tap and no disruptions. The hospital did not routinely test for Legionella, however.
- Searching disease reports, health officials found no other Legionnaires' cases linked to the hospital in the 6 months before or after the transplants. With cases this close together, a hospital water source would be expected to cause more.
- No specimens from the donor or either lung recipient were left to test: donors aren't required to have such specimens saved, and the patients' samples yielded no isolates or had been discarded.
Why the lungs are the likely source
Without genetic proof, three points still suggest the donor lungs:
- The two patients had different Legionella species — consistent with river water, which may hold more kinds than tap water.
- The hospital's water systems showed no problems.
- No other cases occurred at the hospital in the surrounding 12 months, and no other exposure source was found.
Limits: the donor could not be tested; patient specimens weren't available for further analysis; the heart and kidney recipients weren't tested; and the hospital's water wasn't tested for Legionella around the time of surgery, so it can't be fully ruled out.
What it means for clinicians
- Legionnaires' disease has risen sharply over the past decade, to a peak of 2.71 cases per 100,000 people in 2018; about 18% of cases involve exposure in a health care facility. The Centers for Medicare & Medicaid Services requires every acute care hospital to run a water management program against Legionella.
- Drowned donors have previously passed bacterial and fungal infections to recipients, some fatal. Clinicians caring for recipients of organs from donors who drowned in fresh water should suspect legionellosis if complications develop, even without classic symptoms, and may tailor post-transplant antibiotics to cover waterborne organisms.
- Suspected donor-derived infections must be reported to the United Network for Organ Sharing or OPTN and to public health authorities.
- Legionnaires' disease needs organism-specific testing; quick diagnosis and treatment improve the chance of full recovery.
Sources
Based on McGinnis S, Free RJ, Burnell J, et al., "Suspected Legionella Transmission from a Single Donor to Two Lung Transplant Recipients — Pennsylvania, May 2022," Morbidity and Mortality Weekly Report 72(37), CDC; a work of the United States government in the public domain.
Licencia: CC0 1.0 (dominio público) · Adaptado de www.cdc.gov
1
0
0
0
Comentarios
