A rare case of a tick-borne illness transmitted through a kidney transplant highlights the unexpected risks associated with organ donation. Both the donor and recipient contracted ehrlichiosis, a bacterial infection typically spread by ticks, after the transplant surgery. This unusual case, documented in the journal Emerging Infectious Diseases, underscores the importance of vigilance in detecting and treating such infections.
Ehrlichiosis is caused by several species of bacteria, most commonly Ehrlichia chaffeensis. While the disease is relatively rare, reported cases have been on the rise, increasing from 201 in 2000 to 1,570 in 2022 in the U.S. Transmission through organ transplantation, however, is exceptionally uncommon.
The case involved a 33-year-old kidney donor from Minnesota and a 24-year-old recipient from Wisconsin. The donor passed all standard pre-transplant screening tests, which don’t typically include screening for ehrlichiosis. Following the surgery, the donor developed a rash, muscle pain, and weakness, later diagnosed as rhabdomyolysis. The recipient initially appeared healthy but developed fever, joint pain, and fluid buildup around his kidneys a week later. Tests revealed the presence of E. chaffeensis bacteria, confirming ehrlichiosis.
The recipient’s lack of typical risk factors for ehrlichiosis, such as recent travel to tick-infested areas, prompted a thorough investigation. It was discovered that the donor had been on a hunting trip in Kansas a month prior to the surgery, where he had removed several ticks from his clothing and body. He had also experienced a brief illness before the transplant, which he attributed to food poisoning. Further testing confirmed the presence of the bacteria in both the donor and the transplanted kidney.
This investigation strongly suggests that the donor contracted ehrlichiosis through a tick bite in Kansas and subsequently transmitted the infection to the recipient through the transplanted kidney. Both individuals received appropriate antibiotic treatment and recovered fully.
While this mode of transmission is exceedingly rare, it’s not unprecedented. A 2021 study reported two deaths linked to ehrlichiosis transmitted through kidney transplants from a deceased donor. Although the overall fatality rate for ehrlichiosis is around 1%, transplant recipients are at higher risk due to their use of immunosuppressant drugs to prevent organ rejection.
Due to the rarity of ehrlichiosis transmission through organ donation, routine screening of donors isn’t currently considered necessary. However, the authors of the study emphasize the importance of awareness among transplant professionals. They recommend vigilance for tick-borne infections in potential donors, particularly those with a history of exposure to ticks.
In conclusion, this case highlights the potential for unexpected transmission of tick-borne illnesses through organ transplantation. While rare, such cases underscore the need for ongoing vigilance and prompt diagnosis and treatment to ensure the safety and well-being of both donors and recipients.
