Journal of Kidney

Donor of Kidney Transplant with Brucellosis

Adam Wells^{* *}Correspondence: Adam Wells, Editorial office, Journal of Kidney, Belgium, Email:

Author info »

Introduction

In many countries, including China, brucellosis is an endemic systemic zoonotic illness brought on by an intracellular bacterial infection. Although the actual prevalence of brucellosis is unknown, it has significantly increased in recent years, with up to 500,000 new cases being recorded year, resulting in significant economic losses and a serious threat to public health. An infrequently seen complication is brucellosis after kidney transplantation. Complex and nonspecific associated medical symptoms might result in incorrect diagnoses, inadequate care, and chronic disease. There have been seven kidney transplant-related instances of brucellosis documented to date, but none of them have been definitively linked to organ transplantation from donors; instead, they all involved recipients. In endemic regions, brucellosis is a typical systemic infectious disease, and the epidemic status in China is unsatisfactory. The lack of specificity in the clinical signs and symptoms of brucellosis makes early diagnosis challenging. Fever and nonspecific symptoms such as malaise, sweats, anorexia, and headache are the most prevalent clinical characteristics. Fever was the most prevalent clinical characteristic in the prior cases (6 cases of 7 cases), which is consistent with our case. Although the serum agglutination test is a reliable sign of the disease, there are no recognized, distinct diagnostic guidelines for brucellosis; instead, the gold standard is thought to be bacterial culture, with test findings satisfying a higher standard in cases of delayed treatment.

Occupational disease brucellosis is typically spread through close contact with infected animals, however, it can also spread through other means such as blood transfusion, sex, and hematopoietic stem cell transplantation. According to earlier studies, kidney transplant recipients with either new or recurrent brucellosis had a history of having close contact with animals or animal products, such as raw milk, or they were at a high risk of contracting the disease due to circumstances like travel to an endemic region. In our case, the donor was a pig industry employee, although both receivers said they had no contact with animals. A kidney transplant can transfer brucellosis, and cultures of donor blood, kidney preservation solution, and recipient blood all proved brucellosis positivity. This appears to be an unusual method of brucellosis transmission. The World Health Organization (WHO) has recommended doxycycline with streptomycin or gentamicin as optional therapies for brucellosis. Doxycycline with rifampicin is the primary kind of alternative medicine. The treatment regimens in earlier reported cases varied, but the most frequent ones were rifampin plus sulfamethoxazole-trimethoprim or rifampin plus doxycycline. Antimicrobial medications should be used with caution in kidney transplant patients,especially in the first few days following surgery, since they may interact with immunosuppressive medications and interfere with the monitoring of immunosuppressive agent concentrations. For instance, in patients receiving tacrolimus, the effects of rifampin on the cytochrome P-450 3A system can change the serum levels of tacrolimus. To raise the serum levels of tacrolimus, diltiazem was given along with tacrolimus. Patients showed no brucellosis-related symptoms, such as fever or colliquative perspiration, in the days that followed, and three more blood cultures to check for Brucella were negative, indicating that the disease had been successfully treated.