Outcomes in solid organ transplant recipients receiving organs from a donor with Fusarium solani species complex meningitis.

BACKGROUND: Five organs (heart, right lung, liver, right, and left kidneys) from a deceased patient were transplanted into five recipients in four US states; the deceased patient was identified as part of a healthcare-associated fungal meningitis outbreak among patients who underwent epidural anesthesia in Matamoros, Mexico. METHODS: After transplant surgeries occurred, Fusarium solani species complex, a fungal pathogen with a high case-mortality rate, was identified in cerebrospinal fluid from the organ donor by metagenomic next-generation sequencing (mNGS) and fungal-specific polymerase chain reaction and in plasma by mNGS. RESULTS: Four of five transplant recipients received recommended voriconazole prophylaxis; four were monitored weekly by serum (1-3)-ß-d-glucan testing. All five were monitored for signs of infection for at least 3 months following transplantation. The liver recipient had graft failure, which was attributed to an etiology unrelated to fungal infection. No fungal DNA was identified in sections of the explanted liver, suggesting that F. solani species complex did not contribute to graft failure. The remaining recipients experienced no signs or symptoms suggestive of fusariosis. CONCLUSION: Antifungal prophylaxis may be useful in preventing donor-derived infections in recipients of organs from donors that are found to have Fusarium meningitis.

Enterococcus gallinarum endophthalmitis and meningitis in an allogeneic hematopoietic stem cell transplant patient: A case report and literature review.

Endogenous endophthalmitis caused by Enterococcus gallinarum, an organism with intrinsic resistance to vancomycin, has rarely been reported. We present a case of persistent E. gallinarum bacteremia in a female recipient of hematopoietic stem cell transplant (HSCT) complicated by endophthalmitis and meningoventriculitis, resulting in a fatal outcome despite treatment with intravenous ampicillin and daptomycin. Treatment of endophthalmitis often presents a challenge due to the lack of options for antimicrobials with reliable ocular penetration. Therapeutic decisions can become particularly complex with the involvement of drug-resistant pathogens and host characteristics that limit the choice of antimicrobials due to drug toxicity. This case illustrates a rare manifestation of an opportunistic pathogen.

L'endophtalmite endogène causée par l'Enterococcus gallinarum, un organisme ayant une résistance intrinsèque à la vancomycine, est rarement déclarée. Les auteurs présentent un cas de bactériémie à E. gallinarum persistante chez une femme après une greffe de cellules souches hématopoïétiques compliquée par une endophtalmite et une méningoventriculite dont l'issue a été fatale malgré un traitement à l'ampicilline et à la daptomycine par voie intraveineuse. Il est souvent difficile de traiter l'endophtalmite, à cause du manque d'antimicrobiens ayant une pénétration oculaire fiable. Les décisions thérapeutiques peuvent devenir particulièrement complexes en raison des agents pathogènes pharmacorésistants et des caractéristiques de l'hôte qui limitent le choix d'antimicrobiens, dont la toxicité est élevée. Ce cas illustre une manifestation rare d'agent pathogène opportuniste.