Mombu the Medicine Forum sponsored links

Go Back   Mombu the Medicine Forum > Medicine > Allograft-Related Disease Transmission (endophthalmitis intraocular streptococcus vitrectomy colon)
User Name
REGISTER NOW! Mark Forums Read

sponsored links

1 22nd January 00:10
External User
Posts: 1
Default Allograft-Related Disease Transmission (endophthalmitis intraocular streptococcus vitrectomy colon)

Allograft-Related Disease Transmission

Use of cadaveric allografts is increasingly common and generally
considered safe. However, 3 sobering reports of allograft-associated
disease transmission have recently been published.

The first report details a group A streptococcus (GAS) joint infection
leading to fasciitis after anterior cruciate ligament repair using a
cadaveric hemi-patellar tendon allograft. Blood, wound, and explanted
tissue all grew GAS. The patient's convalescence was protracted and
complicated. Five other recipients of tendon allografts from the same
cadaver had no such complications. Preprocessing cultures of the donor's
tissue revealed GAS genetically identical to that isolated from the
infected recipient, but all postprocessing cultures were all reported to
be negative. The processor later suspended distribution of allografts
containing bone.

The second article describes the first 2 reported cases of
transplant-related endophthalmitis caused by Clostridium perfringens.
The patients received corneas harvested from the same donor, who had
died from complications of metastatic colon cancer -- a known risk for
C. perfringens infection. Both patients required vitrectomy and
intraocular antibiotics, and 1 had substantial vision loss. Cultures of
the corneal tissue, collected just before surgery, grew C. perfringens,
but the results were not reported until several days later.

The third report revisits an outbreak of Creutzfeldt-Jakob disease (CJD)
associated with cadaveric dura mater allografts in Japan. Ninety-seven
cases (about 1 per 1250 grafts) occurred from 1985 to 2002; the LYODURA
dural graft manufactured before mid-1987 is the only identified source
of transmission. Currently, the mean age of onset is 55 years (vs. 66
for sporadic CJD), the shortest latency period is 14 months, and the
longest latency period is 23 years, but cases continue to be identified.
The apparent rate decline among patients grafted after 1991 may stem
from improved processing procedures introduced in Japan in 1987.

Comment: As technical proficiency and immunomodulation therapy improve,
cadaveric allografting will undoubtedly become more common. Better
screening and sterilization procedures might well have prevented many,
if not all, of the cases of disease transmission described here.
Providers of allograft tissues must be required to meet extremely
stringent processing and screening standards. In patients developing
CJD, clinicians must take a complete history, including transplantation
events, because another potential external source of CJD (ingestion of
meat from animals with spongiform encephalopathy) has now been

Stephen G. Baum, MD

Published in Journal Watch Infectious Diseases January 16, 2004


Invasive Streptococcus pyogenes after allograft implantation --
Colorado, 2003. MMWR Morb Mortal Wkly Rep 2003 Dec 5; 52:1173-6.

Clostridial endophthalmitis after cornea transplantation -- Florida,
2003. MMWR Morb Mortal Wkly Rep 2003 Dec 5; 52:1176-9.
[Medline abstract][Download citation]

Update: Creutzfeldt-Jakob disease associated with cadaveric dura mater
grafts -- Japan, 1979-2003. MMWR Morb Mortal Wkly Rep 2003 Dec 5;
[Medline abstract][Download citation]
  Reply With Quote

  sponsored links


Thread Tools
Display Modes

Copyright 2006 - Dies Mies Jeschet Boenedoesef Douvema Enitemaus -