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Volume 25, Number 4—April 2019
Research

Francisella tularensis Transmission by Solid Organ Transplantation, 20171

Christina A. NelsonComments to Author , Christian Murua, Jefferson M. Jones, Kelli Mohler, Ying Zhang, Landon Wiggins, Natalie A. Kwit2, Laurel Respicio-Kingry, Luke C. Kingry, Jeannine M. Petersen, Jennifer Brown, Saima Aslam, Melissa Krafft, Shadaba Asad, Hikmat N. Dagher, John Ham, Luis H. Medina-Garcia, Kevin Burns, Walter E. Kelley, Alison F. Hinckley, Pallavi Annambhotla, Karen Carifo, Anthony Gonzalez, Elizabeth Helsel, Joseph Iser, Michael Johnson, Curtis L. Fritz, Sridhar V. Basavaraju, and the Tularemia in Transplant Recipients Investigation Team
Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (C.A. Nelson, N.A. Kwit, L. Respicio-Kingry, L.C. Kingry, J.M. Petersen, A.F. Hinckley); Southern Nevada Health District, Las Vegas, Nevada, USA (C. Murua, Y. Zhang, K. Carifo, J. Iser, M. Johnson); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.M. Jones, P. Annambhotla, S.V. Basavaraju); Phoenix Area Indian Health Service, Phoenix, Arizona, USA (K. Mohler, L. Wiggins, E. Helsel); University of California Davis Medical Center, Sacramento, California, USA (J. Brown); University of California, San Diego, California, USA (S. Aslam, M. Krafft); University Medical Center of Southern Nevada, Las Vegas (S. Asad, J. Ham, L.H. Medina-Garcia); Sunrise Hospital and Medical Center, Las Vegas (H.N. Dagher); Nevada Donor Network, Las Vegas (K. Burns); American Red Cross, Salt Lake City, Utah, USA (W.E. Kelley); University of Arizona College of Medicine, Tucson, Arizona, USA (W.E. Kelley); Sacramento County Public Health Laboratory, Sacramento (A. Gonzalez); California Department of Public Health, Sacramento (C.L. Fritz)

Main Article

Table

Culture and serology results for samples from Francisella tularensis–infected organ donor and organ recipients, United States, 2017

Patient, outcome, samples tested Results
Donor
Blood Culture negative
Endotracheal aspirate Culture negative
Urine Culture negative
Bilateral bronchial washes Culture negative
Lymph node, after brain death Culture negative
Spleen tissue, after brain death Culture positive for Francisella tularensis
Serum, after brain death
 Serology positive (titer 1:128)*
Kidney recipient 1, died
Blood Culture positive for F. tularensis
Cerebrospinal fluid, postmortem Culture positive for F. tularensis
Kidney tissue, postmortem Culture positive for F. tularensis
Bone marrow, postmortem
 Culture positive for F. tularensis
Kidney recipient 2, discharged
Blood Culture positive for F. tularensis
Dialysate Culture positive for F. tularensis
Biliary fluid Culture positive for F. tularensis
Peritoneal dialysis catheter tip
 Culture positive for F. tularensis
Heart recipient, discharged
Blood Culture negative†
Serum Serology negative

*Antibody titer may be artificially low because of the large volume of blood products and other fluids that the patient received. Presence of a mounted immune response, as evidenced by seropositivity, might have contributed to negative culture results in all specimens other than spleen tissue.
†Before transplantation, the patient received ciprofloxacin and ceftriaxone for bacteremia related to a colonized ventricular assist device. At the time of sample collection, the patient had received a final dose of ciprofloxacin the previous day and a final dose of ceftriaxone that morning. Subsequent blood cultures were collected while the patient was receiving antimicrobial drugs for presumed sepsis and were negative.

Main Article

1Results from this investigation were presented at the 9th International Conference on Tularemia; October 16–19, 2018; Montreal, Québec, Canada.

2Current affiliation: Vermont Department of Health, Burlington, Vermont, USA.

3Members of the team are listed at the end of this article.

Page created: March 18, 2019
Page updated: March 18, 2019
Page reviewed: March 18, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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