Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Introduction: An association with Ureplasma urealyticum, Ureaplasma parvum and Mycoplasma hominis infections has been proposed to play a causative role in hyperammonemia syndrome (HS), a rare but often fatal condition observed in LTRs.
Methods: We describe four cases of HS among LTRs at our center between November 2012 and October 2016. We also report the results of a screening program implemented in June 2017 in which the first post-transplant bronchoscopy specimen is tested by PCR to detect the 16S rRNA gene of the Mycoplasmataceae family, followed by sequencing for speciation.
Results: The four cases from our center are summarized below.
|Case 1||Case 2||Case 3||Case 4|
|Transplant indication||Bronchiectasis||IPF||IPF||Pulmonary hypertension|
|Presentation||Decreased LOC, seizures (day 11)||Encephalopathy (day 3)||Decreased LOC (day 4)||Encephalopathy, seizures (day 4)|
|Imaging||MRI – diffuse cerebral edema||CT – diffuse cerebral edema, tonsillar herniation||CT – normal||MRI – diffuse cerebral edema|
|Peak ammonia ([mu]mol/L)||479||678||188||646|
|Microbiology||U. urealyticum, M. hominis from BAL, venous catheter tip||M. hominis from chest tube and BAL||M. hominis, U. urealyticium, M. anseris from BAL||U. urealyticum, M. hominis from BAL|
|Outcome||Death (day 34)||Death (day 9)||Alive||Death (day 20)|
BAL – Bronchoalveolar lavage. LOC – Level of consciousness. IPF – Idiopathic Pulmonary Fibrosis
Since initiation of our protocol we have tested 18 of 37 sequential LTRs. Seven patients had positive results: three M. salivarium, two M. pneumoniae, one U. parvum and one M. hominis and M. anseris co-infection. There have been no cases of HS during the surveillance period and one case of M. hominis infection with pleural space and wound infection.
Conclusion: Our HS cases suggest an association with Mycoplasma/Ureaplasma infection. Surveillance of donors and recipients early post-transplant may provide insight into the incidence and source of these infections and permit pre-emptive treatment that might prevent not only HS but also surgical site infections, pleuritis and mediastinitis that have been associated with M. hominis infection.
CITATION INFORMATION: Somerville L., Sligl W., Zelyas N., Lien D., Preiksaitis J. Surveillance for Mycoplasma/Ureaplasma Infection in Lung Transplant Recipients (LTRs) Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Somerville L, Sligl W, Zelyas N, Lien D, Preiksaitis J. Surveillance for Mycoplasma/Ureaplasma Infection in Lung Transplant Recipients (LTRs) [abstract]. https://atcmeetingabstracts.com/abstract/surveillance-for-mycoplasma-ureaplasma-infection-in-lung-transplant-recipients-ltrs/. Accessed July 22, 2019.
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