Transmission of Rabies Virus from an Organ Donor to Four Transplant Recipients
Arjun Srinivasan, M.D., Elizabeth C. Burton, M.D., Matthew J. Kuehnert, M.D., Charles Rupprecht, V.M.D., Ph.D., William L. Sutker, M.D., Thomas G. Ksiazek, D.V.M., Ph.D., Christopher D. Paddock, M.D., Jeannette Guarner, M.D., Wun-Ju Shieh, M.D., Ph.D., Cynthia Goldsmith, M.S., Cathleen A. Hanlon, V.M.D., Ph.D., James Zoretic, M.D., Bernard Fischbach, M.D., Michael Niezgoda, M.S., Waleed H. El-Feky, M.D., Lillian Orciari, M.S., Edmund Q. Sanchez, M.D., Anna Likos, M.D., M.P.H., Goran B. Klintmalm, M.D., Denise Cardo, M.D., James LeDuc, Ph.D., Mary E. Chamberland, M.D., M.P.H., Daniel B. Jernigan, M.D., M.P.H., Sherif R. Zaki, M.D., Ph.D., for the Rabies in Transplant Recipients Investigation Team
Background In 2004, four recipients of kidneys, a liver, andan arterial segment from a common organ donor died of encephalitisof an unknown cause.
Methods We reviewed the medical records of the organ donor andthe recipients. Blood, cerebrospinal fluid, and tissues fromthe recipients were tested with a variety of assays and pathologicalstains for numerous causes of encephalitis. Samples from therecipients were also inoculated into mice.
Results The organ donor had been healthy before having a subarachnoidhemorrhage that led to his death. Encephalitis developed inall four recipients within 30 days after transplantation andwas accompanied by rapid neurologic deterioration characterizedby agitated delirium, seizures, respiratory failure, and coma.They died an average of 13 days after the onset of neurologic symptoms.Mice inoculated with samples from the affected patientsbecame ill seven to eight days later, and electron microscopyof central nervous system (CNS) tissue demonstrated rhabdovirusparticles. Rabies-specific immunohistochemical and direct fluorescenceantibody staining demonstrated rabies virus in multiple tissuesfrom all recipients. Cytoplasmic inclusions consistent withNegri bodies were seen in CNS tissue from all recipients. Antibodiesagainst rabies virus were present in three of the four recipientsand the donor. The donor had told others of being bitten bya bat.
Conclusions This report documenting the transmission of rabiesvirus from an organ donor to multiple recipients underscoresthe challenges of preventing and detecting transmission of unusualpathogens through transplantation.
Source Information
From the Divisions of Healthcare Quality Promotion (A.S., D.C., D.B.J.) and Viral and Rickettsial Diseases (M.J.K., C.R., T.G.K., C.D.P., J.G., W.-J.S., C.G., C.A.H., M.N., L.O., J.L., M.E.C., S.R.Z.), National Center for Infectious Diseases, and the Epidemic Intelligence Service Branch, Division of Applied Public Health Training, Epidemiology Program Office (A.L.), Centers for Disease Control and Prevention, Atlanta; Baylor University Medical Center, Dallas (E.C.B., W.L.S., B.F., W.H.E., E.Q.S., G.B.K.); and the Texas Department of State Health Services, Austin (J.Z.).
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