Case report
Ureaplasma Transmitted From Donor Lungs Is Pathogenic After Lung Transplantation

https://doi.org/10.1016/j.athoracsur.2016.09.026Get rights and content

Hyperammonemia is a highly fatal syndrome in lung recipients that is usually refractory to medical therapy. We recently reported that infection by a Mollicute, Ureaplasma, is causative for hyperammonemia and can be successfully treated with antimicrobial agents. However, it remains unknown whether the pathogenic strain of Ureaplasma is donor or recipient derived. Here we provide evidence that donor-derived Ureaplasma infection can be pathogenic. As such, we uncover a previously unknown lethal donor-derived opportunistic infection in lung recipients. Given the high mortality associated with hyperammonemia, strategies for routine donor screening or prophylaxis should be further evaluated in prospective studies.

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We recently discovered that Ureaplasma infection causes the highly fatal hyperammonemia syndrome [3], which affects more than 4% of lung recipients and is characterized by sepsis, altered mental status, and progressively elevated serum ammonia [1]. Ureaplasma urealyticum and U. parvum are fastidious commensal organisms found in the urogenital tract in as many as 40% of healthy men and 80% of healthy women [6]. They are often unrecognized pathogens given their inability to grow on routine

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    Citation Excerpt :

    One of several proposed mechanistic hypotheses has been that urease-producing bacteria of the genitourinary tract may lead to hyperammonemia following lung transplantation due to dissemination in an immunosuppressed state [19,20]. Additionally, hyperammonemia (of 80 μM) was reported in an individual following lung transplantation where the donor had bronchoalveolar lavage positive for U. parvum prior to the procedure [4]. The mechanism of hyperammonemia in lung transplant recipients is still being evaluated, but it may be due to an infectious etiology in an immunocompromised host.

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