Transmission of Lymphocytic Choriomeningitis Virus by Organ Transplantation
Staci A. Fischer, M.D., Mary Beth Graham, M.D., Matthew J. Kuehnert, M.D., Camille N. Kotton, M.D., Arjun Srinivasan, M.D., Francisco M. Marty, M.D., James A. Comer, Ph.D., Jeannette Guarner, M.D., Christopher D. Paddock, M.D., M.P.H.T.M., Dawn L. DeMeo, M.D., M.P.H., Wun-Ju Shieh, M.D., Ph.D., M.P.H., Bobbie R. Erickson, B.S., Utpala Bandy, M.D., M.P.H., Alfred DeMaria, Jr., M.D., Jeffrey P. Davis, M.D., Francis L. Delmonico, M.D., Boris Pavlin, M.D., Anna Likos, M.D., M.P.H., Martin J. Vincent, Ph.D., Tara K. Sealy, B.S., Cynthia S. Goldsmith, M.S., Daniel B. Jernigan, M.D., M.P.H., Pierre E. Rollin, M.D., Michelle M. Packard, M.P.H., Mitesh Patel, B.S., Courtney Rowland, B.S., Rita F. Helfand, M.D., Stuart T. Nichol, Ph.D., Jay A. Fishman, M.D., Thomas Ksiazek, D.V.M., Ph.D., Sherif R. Zaki, M.D., Ph.D., and the LCMV in Transplant Recipients Investigation Team
Background In December 2003 and April 2005, signs and symptomssuggestive of infection developed in two groups of recipientsof solid-organ transplants. Each cluster was investigated becausediagnostic evaluations were unrevealing, and in each a commondonor was recognized.
Methods We examined clinical specimens from the two donors andeight recipients, using viral culture, electron microscopy,serologic testing, molecular analysis, and histopathologicalexamination with immunohistochemical staining to identify acause. Epidemiologic investigations, including interviews, environmentalassessments, and medical-record reviews, were performed to characterizeclinical courses and to determine the cause of the illnesses.
Results Laboratory testing revealed lymphocytic choriomeningitisvirus (LCMV) in all the recipients, with a single, unique strainof LCMV identified in each cluster. In both investigations,LCMV could not be detected in the organ donor. In the 2005 cluster,the donor had had contact in her home with a pet hamster infectedwith an LCMV strain identical to that detected in the organrecipients; no source of LCMV infection was found in the 2003cluster. The transplant recipients had abdominal pain, alteredmental status, thrombocytopenia, elevated aminotransferase levels,coagulopathy, graft dysfunction, and either fever or leukocytosiswithin three weeks after transplantation. Diarrhea, peri-incisionalrash, renal failure, and seizures were variably present. Sevenof the eight recipients died, 9 to 76 days after transplantation.One recipient, who received ribavirin and reduced levels ofimmunosuppressive therapy, survived.
Conclusions We document two clusters of LCMV infection transmittedthrough organ transplantation.
Source Information
From Rhode Island Hospital and Brown Medical School, Providence (S.A.F.); the Medical College of Wisconsin, Milwaukee (M.B.G.); the Divisions of Viral and Rickettsial Diseases (M.J.K., J.A.C., J.G., C.D.P., W.-J.S., B.R.E., B.P., A.L., M.J.V., T.K.S., C.S.G., P.E.R., M.M.P., M.P., C.R., R.F.H., S.T.N., T.K., S.R.Z.) and Healthcare Quality Promotion (A.S., D.B.J.), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta; Massachusetts General Hospital and Harvard Medical School (C.N.K., F.L.D., J.A.F.) and Brigham and Women's Hospital and Harvard Medical School (F.M.M., D.L.D.) — all in Boston; the Rhode Island Department of Health, Providence (U.B.); the Massachusetts Department of Public Health, Boston (A.D.); the Wisconsin Department of Health and Family Services, Madison (J.P.D.); and the New England Organ Bank, Newton, Mass. (F.L.D.). Drs. Ksiazek and Zaki contributed equally to this article.
Address reprint requests to Dr. Kuehnert at the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop A-30, Atlanta, GA 30333, or at mkuehnert{at}cdc.gov.
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