Solid Organ Transplant-Transmitted Tuberculosis Linked to a Community Outbreak - California, 2015 - PubMed (original) (raw)

. 2017 Aug 4;66(30):801-805.

doi: 10.15585/mmwr.mm6630a1.

Pennan M Barry, Pallavi Annambhotla, Carol Greene, Martin Cilnis, Peter Chin-Hong, Nicholas Arger, Louise McNitt, Nikole Neidlinger, Neha Shah, Sridhar V Basavaraju, Matthew Kuehnert, Tambi Shaw

Solid Organ Transplant-Transmitted Tuberculosis Linked to a Community Outbreak - California, 2015

Alexander Kay et al. MMWR Morb Mortal Wkly Rep. 2017.

Abstract

In the spring of 2015, a local health department (LHD) in county A notified the California Department of Public Health (CDPH) about three adults with close ties to one another and a congregate community site who had received diagnoses of tuberculosis (TB) disease within a 3-month period. Subsequent review revealed matching TB genotypes indicating that the cases were likely part of a chain of TB transmission. Only three TB cases in California in the preceding 2 years shared this same genotype. One of those three previous cases occurred in a lung-transplant recipient who had no identified epidemiologic links to the outbreak. CDPH, multiple LHDs, and CDC conducted an investigation and determined that the lung-transplant donor (patient 1) was epidemiologically linked to the three outbreak cases and had a tuberculin skin test (TST) conversion detected in 2012 upon reentry at a local jail. Three other solid organ recipients from this donor were identified; none had developed TB disease. This investigation suggests that review of organ donors' medical records from high-risk environments, such as jails, might reveal additional information about TB risk. The evaluation of TB in organ recipients could include genotyping analysis (1) and coordination among local, state, and national partners to evaluate the potential for donor-derived TB.

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Conflict of interest statement

Conflict of Interest: No conflicts of interest were reported.

Figures

FIGURE

FIGURE

Timeline of events and epidemiologic links for a tuberculosis (TB) outbreak (N = 7*) in which an organ donor was infected with TB by one outbreak case and then transmitted TB via lung transplant to an organ recipient† — California, 2014–2015 * Includes one organ donor with TB infection and six patients diagnosed with TB disease during January 2012–May 2015 with matching TB genotypes (and, if available, whole-genome sequencing results consistent with transmission), in addition to an epidemiologic link between patients. Definitions of the strength of epidemiologic links are adapted from National TB Controllers Association/CDC Advisory Group on Tuberculosis Genotyping. Guide to the application of genotyping to tuberculosis prevention and control. Atlanta, GA: US Department of Health and Human Services, CDC; 2004. † The lung-transplant donor (patient 1) had a predonation tuberculin skin test (TST) and interferon gamma release assay that were negative and indeterminate, respectively. However, investigators learned that the donor had a positive TST result upon reentry to a local jail in early 2012 after having a documented negative TST <2 years earlier during a previous incarceration.

References

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