No testing or screening for Leishmaniasis or Lyme disease is carried out for allogeneic tissue retrieval. With some cases having a long period between bite and symptoms is it possible that it may be transmitted by tissue taken before any symptoms or signs are noted even at autopsy? The tissue undergoes a cleansing process, antibiotic soak and low dose irradiation to terminally sterilise.
Theoretically, low numbers of Borrelia might be present in tendon tissue of the donor. It is, however, more than unlikely, that they prevent allograft take by the recipient. Based on clinical grounds (and Borrelia serology before and six weeks after grafting), a possible infection can be recognized and treated with ceftriaxon.
The host cell for Leishmania is macrophages/monocytes/dendritic cells. There is no report that they have ever been detected in tendon tissue.
In summary, I don´t see a significant risk.
Thanks you for your reply Professor- would you think it even a possibility that a diagnosis of Lyme Disease (in the graft recipient )made 18months after surgery may be donor- graft related. The tendon donor did not have any clinical signs or evidence of Lyme disease. I have searched the EU NOTIFY website and cannot see any reported transmission.
Leishmania is an intracellular parasite and thus live obligately inside cells of immune system such as macrophages and neutrophils. To my knowledge, this mode of transmission haven't been reported. However, visceral leishmaniasis has been reported after renal transplantation. See
http://ndt.oxfordjournals.org/content/14/12/2941.full.pdf+html
Thank you for your reply. I note that renal tranplant recipients in endemic areas have the highest reported transmission incidence. As these allografts are vascularised, I would assume that the transmission is facilitated by this. The tendon graft is highly processed and could be also irradiated at 15KGy then frozen at -80oC -could viable paracite/s survive this and be transmitted?
No, I don’t think; Leishmania is temperature sensitivity parasite. Although, temperature determines localization of parasite in the body; such as visceral spp can grow in internal organs of relatively higher temperature, but those causing cutaneous lesions grow best at lower temperatures but all temprature around 30 degree C. Further, the parasite (if any) will be killed during freezing and thawing! so no worry!
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