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World J Transplant. Mar 31, 2020; 10(3): 47-63
Published online Mar 31, 2020. doi: 10.5500/wjt.v10.i3.47
Emerging and neglected zoonoses in transplant population
Anna Mrzljak, Rafaela Novak, Nenad Pandak, Irena Tabain, Lucija Franusic, Ljubo Barbic, Maja Bogdanic, Vladimir Savic, Danko Mikulic, Jadranka Pavicic-Saric, Vladimir Stevanovic, Tatjana Vilibic-Cavlek
Anna Mrzljak, Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
Anna Mrzljak, Rafaela Novak, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Nenad Pandak, Depatment of Medicine, The Royal Hospital Muscat, Muscat 111, Oman
Irena Tabain, Maja Bogdanic, Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
Lucija Franusic, General Hospital Dubrovnik, Dubrovnik 20000, Croatia
Ljubo Barbic, Vladimir Stevanovic, Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
Vladimir Savic, Poultry Center, Croatian Veterinary Institute, Zagreb 10000, Croatia
Danko Mikulic, Department of Abdominal and Transplant Surgery, Merkur University Hospital, Zagreb 10000, Croatia
Jadranka Pavicic-Saric, Department of Anesthesiology and Intensive Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Tatjana Vilibic-Cavlek, Department of Virology, Croatian Institute of Public Health; School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Author contributions: Mrzljak A and Vilibic-Cavlek T made contributions to conception and design of the study, involved in drafting and revising the manuscript critically; Novak R, Pandak N, Tabain I, Franusic L, Bogdanic M, Barbic L, Savic V, Mikulic D, Pavicic-Saric J and Stevanovic V were involved in collecting data and drafting the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Anna Mrzljak, FEBG, MD, PhD, Associate Professor, Department of Medicine, Merkur University Hospital, Zajceva 19, Zagreb 10000, Croatia. anna.mrzljak@mef.hr
Received: December 22, 2019
Peer-review started: December 22, 2019
First decision: February 20, 2020
Revised: March 15, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: March 31, 2020
Processing time: 99 Days and 11.2 Hours
Abstract

Zoonoses represent a problem of rising importance in the transplant population. A close relationship and changes between human, animal and environmental health (“One Health” concept) significantly influence the transmission and distribution of zoonotic diseases. The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population. Many reports on donor-derived or naturally acquired (re-)emerging arboviral infections such as dengue, chikungunya, West Nile, tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts. Hepatitis E virus has emerged as a serious problem after solid organ transplantation (SOT), leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes. Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality. In addition, ehrlichiosis may be more severe with higher case-fatality rates in SOT recipients. Some unusual or severe presentations of borreliosis, anaplasmosis and rickettsioses were also reported among transplant patients. Moreover, toxoplasmosis as infectious complication is a well-recognized zoonosis in this population. Although rabies transmission through SOT transplantation has rarely been reported, it has become a notable problem in some countries. Since the spreading trends of zoonoses are likely to continue, the awareness, recognition and treatment of zoonotic infections among transplant professionals should be imperative.

Keywords: Zoonoses; Solid-organ transplant; Vector-borne diseases; Non-vector borne diseases; Viruses; Bacteria; Parasites

Core tip: The importance of zoonotic diseases in the transplant population is rising. Given the current diversity and extent of zoonotic pathogens, modes of transmission and clinical presentation in immunocompromised hosts, this manuscript aims to summarize the published literature on emerging and neglected zoonoses in the transplant population.