Transmission of toxoplasmosis in two renal allograft recipients receiving an organ from the same donor.

Toxoplasma gondii is a ubiquitous protozoan parasite. After acute infection it continues to exist as cysts in the muscles and brain. Recipients of organ allografts are susceptible to the disease as a result of reactivation of quiescent infection either by transmission from the organ donor or by consumption of undercooked meat. We describe 2 cases of fatal toxoplasmosis in renal allograft recipients who received their organs from the same cadaveric donor. Both recipients died 5 weeks after renal transplantation, within days of each other. Multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite was found in the transplanted kidney, either at the time of insertion or at autopsy. Neither recipient had serologic evidence of previous exposure to T. gondii. The donor had positive IgG but indeterminate IgM antibodies suggesting acute infection at the time of death; there was no clinical suspicion that the donor died from acute toxoplasmosis. We conclude that toxoplasmosis was transmitted by the donor kidneys. In an attempt to minimize the possibility of future transmission, donors are now tested for anti-toxoplasma IgM antibodies and recipients are treated with trimethoprim/sulfamethoxazole for the first 6 months after renal transplantation.

Death due to malathion poisoning.

Malathion is a commonly available insecticide with relatively low toxicity. A study was undertaken in South Australia over a 20-year period to assess the characteristic features of deaths associated with malathion. A total of 5 cases were found, in each of which exposure to malathion had been intentional. The male to female ratio was 2:3 with an age range of 32 to 80 years (mean = 57 yr). In four cases malathion had been ingested and in one case death had resulted from an intravenous injection of insecticide. Ingestion of large volumes of malathion was associated with contamination of the mortuary due to postmortem regurgitation in at least one case. The study also demonstrates that suicides due to malathion poisoning were uncommon in thispopulation, representing only 0.2% of the 3,202 suicides recorded at the Forensic Science Centre over the 20year period.

Sigmoid volvulus and unexpected death in the elderly.

An 84-year-old female who was found unexpectedly dead at her home was shown at autopsy to have a massively dilated sigmoid colon with twisting of the lower colon on an unusually long mesentery. The volvulus had caused mechanical obstruction of the bowel with critical reduction of the blood supply resulting in intestinal infarction. Death was due to ischaemic necrosis of the lower large intestine with significant fluid and electrolyte sequestration within the bowel lumen, associated with disseminated sepsis. Gastrointestinal disorders that may result in unexpected death are uncommon in adults and may present atypically in the elderly. The diagnosis of unexpected death due to an infarcted sigmoid volvulus may not be established until an autopsy has been undertaken.