Lung transplant recipients likely to contract Legionnaires' disease from the donor

A recent report published in Morbidity And Mortality Weekly Report by Shannon McGinnis and colleagues reveals that two patients who received lung transplants from a drowning victim developed Legionnaires' disease, likely transmitted through the donated organs. The cases were reported in a Philadelphia hospital, marking the first known instance of Legionella transmission through organ transplantation.

Key findings of the report:

● Two lung transplant recipients, a woman in her 70s and a man in his 60s, developed Legionnaires' disease after receiving lungs from a donor who had drowned in a river.

● The donor had been submerged for more than 5 minutes and was declared brain dead despite resuscitation efforts.

● Both lung recipients experienced complications post-transplant, with one patient recovering fully after treatment with doxycycline.

● The second patient, who also received doxycycline, initially showed clinical improvement but ultimately succumbed to respiratory failure due to a mucous plug six months after the transplant.

● Donor-derived infections are required to be reported to relevant authorities for investigation when they occur unexpectedly.

Specimens collected from the patients and the donor did not result in isolates after testing or were discarded before further analysis, hindering the identification of the specific Legionella species.

This case highlights the potential risk of Legionnaires' disease transmission through organ transplantation, particularly from donors who may have been exposed to freshwater sources. Healthcare providers are advised to maintain a high level of suspicion for Legionellosis in organ recipients with atypical clinical symptoms, and post-transplant antimicrobial treatment should consider agents effective against water borne organisms.

The report underscores the importance of organ donors' thorough evaluation and testing for infectious diseases, even in cases where the cause of death is not directly linked to infections. Organ transplant recipients and their healthcare teams should remain vigilant for any signs of unusual infections, as prompt diagnosis and treatment are crucial for patient outcomes.

Reference:

Morbidity and Mortality Weekly Report McGinnis S, et al "Suspected Legionella transmission from a single donor to two lung transplant recipients -- Pennsylvania, May 2022" MMWR 2023; DOI: 10.15585/mmwr.mm7237a1.