In the Journals

Compromised live cell therapy results in outbreak of Q fever

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October 2, 2015

A 2014 outbreak of Q fever in five New York residents and one Canadian may be linked to live cell therapy procedures conducted in Germany, according to recently published research.

“The treatment known as live cell therapy is a type of xenotransplantation when it involves administration of live cells from a nonhuman animal source into a human recipient,” researchers wrote in MMWR. “Xenotransplantation carries a public health risk for transmission of known and unknown infectious agents from the donor organism to the human recipient and possible recombination or reassortment to form new pathogens.”

A Canada resident sought medical care in June 2014 for fever, pain and erythema and received a diagnosis of Q fever — a zoonotic disease caused by Coxiella burnetii — in July 2014. She recently had received intramuscular injections of fetal sheep cells from a German physician, leading the Public Health Agency of Canada to notify German authorities. The physician who performed the injections notified patients of potential Q fever exposure, which led to five more diagnoses in New York as confirmed by immunoglobulin G titer testing.

These five U.S. patients reported traveling in a group of 10 to 15 persons to receive the injections, but the identities of these other recipients are unknown. Median patient age among the six identified cases was 62 years, and only one patient reported other potential exposure to Q fever. Symptoms began about 1 week after therapy and lasted from 10 to 90 days, although three patients reported fatigue, chills, sweats and difficulty sleeping for about 9 months after the injections.

Each patient was interviewed by local health departments, but only two of the U.S. patients agreed to a follow-up. They reported traveling as a group to Germany for the injections twice a year for the previous 5 years, and that they were not informed of Q fever risks before treatment.

“This outbreak highlights one of the public health issues associated with xenotourism, the travel outside a country of residence for the purpose of participating in xenotransplantation programs,” the researchers wrote. “FDA recommends that xenotransplantation product recipients enrolled in research studies remain under lifelong surveillance with periodic clinical and laboratory monitoring and that both they and their intimate contacts refrain from blood and tissue donation.

“Clinicians should be aware of xenotourism and consider the potential for zoonotic disease in a patient with a history of xenotransplantation.” – by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.

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