Each year, approximately 1.5 million musculoskeletal allografts are distributed for transplantation1. Allograft tissues offer advantages over autografts, such as smaller surgical incisions, reduced operative times, and lack of donor-site morbidity2. A disadvantage of allografts is the potential, albeit low, for disease transmission. Recent investigations have implicated a variety of allografts in the transmission of several microorganisms3-7. We investigated the occurrence of invasive group-A streptococcal disease in a musculoskeletal allograft recipient.
Investigation of the Infected Allograft Recipient
Apreviously healthy seventeen-year-old boy underwent anterior cruciate ligament repair with implantation of a hemi patellar tendon allograft. The following day, pain and erythema developed at the surgical site and the patient had a fever of as much as 39°C. Six days after the procedure, he underwent surgical exploration with arthrotomy of the knee and fasciotomy of the thigh. The allograft tissue was removed. Cultures of the wound aspirate, blood, and explanted tissue demonstrated growth of group-A streptococci.
The postoperative course of the patient was complicated by fluid collection in the affected thigh and knee and persistent fever. Six days after allograft explantation, needle aspiration of the knee yielded fluid which, when sent for culture, demonstrated group-A streptococci, despite a week of treatment with clindamycin and cefazolin. The patient received intravenous antibiotics in the hospital for seventeen days and was discharged with an indwelling venous catheter for continued antibiotic treatment at home.
Investigation of the Allograft Donor
We reviewed the medical records and the autopsy report of the allograft donor, which stated that he had been a healthy man in his thirties who had died three weeks after undergoing elective cervical spinal fusion for degenerative disc disease. Three days before his death, the donor had presented to an emergency department with a diffuse pruritic rash, which was diagnosed as an allergic reaction to medications. The donor then returned …
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