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Abstract: FR-PO774

Donor-Derived Disseminated Bartonella Infection After Renal Transplant

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical


  • Bywater, Laura, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
  • Belga, Sara Maria, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
  • Lan, James H., Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada

Bacillary angiomatosis is a manifestation of the rare infection caused by Bartonella quintana, with disseminated or chronic relapsing infection occurring most often in the immunocompromised. This organism is usually transmitted between hosts via the human body louse. Donor related infection is rare and screening is not routine. Those infected commonly complain of fever, headache, joint pain or weakness. Diagnosis is challenging as typical serologic testing may be negative in the immunocompromised.

Case Description

A 59 year-old male with CKD secondary to biopsy proven lambda light chain AL amyloidosis underwent a deceased donor renal transplant. He received induction immunosuppression with Basiliximab and continued on standard immunosuppression, achieving good graft function, with creatinine 1800mg/dL. The patient did not encounter clinical rejection. His background medical history was significant for amyloidosis, with disease quiescence confirmed on bone marrow aspirate and trephine biopsy pre-transplant. He had travelled extensively, had secure housing and owned a dog and chickens with no other animal exposures.

Over the next several months, the patient presented with recurrent episodes of profound fatigue, weakness, headaches and occasional fever with a septic appearance on clinical examination and associated leukocytosis. Broad microbiological work-up was negative. This included serology for Bartonella species.

Six months after his original presentation, the patient described small cherry red lesions on his thigh, arm and buccal mucosa. Biopsy identified bacillary angiomatosis. Warthin-Starry stains were negative, but B. quintana was confirmed on PCR. Serology later returned a positive result. He was treated for disseminated infection with doxycycline 100mg BID. Rifampicin was not used due to interaction with immunosuppressants. Subsequent testing of donor serum confirmed the presence of B. quintana antibodies. On follow-up, the patient demonstrated improvement with resolving symptoms and lesions.


This case highlights the challenges inherent in atypical donor derived infections. Patient serology was uninformative, being initially negative after several months of symptoms and became positive much later. Given the prolonged period of infection and the inherent difficulties in diagnosis, reviewing risk factors for infection in the donor may have been useful.