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.
Kotton, C. N., Elias, N., Delmonico, F. L., Kradin, R. L.
(2009). Case 15-2009 -- A 25-Year-Old Man with Coma after Cardiac Arrest. NEJM
360: 2118-2125
[Full Text]
Emonet, S. F., Garidou, L., McGavern, D. B., de la Torre, J. C.
(2009). Generation of recombinant lymphocytic choriomeningitis viruses with trisegmented genomes stably expressing two additional genes of interest. Proc. Natl. Acad. Sci. USA
106: 3473-3478
[Abstract][Full Text]
Bowick, G. C., Spratt, H. M., Hogg, A. E., Endsley, J. J., Wiktorowicz, J. E., Kurosky, A., Luxon, B. A., Gorenstein, D. G., Herzog, N. K.
(2009). Analysis of the Differential Host Cell Nuclear Proteome Induced by Attenuated and Virulent Hemorrhagic Arenavirus Infection. J. Virol.
83: 687-700
[Abstract][Full Text]
Zinkernagel, M. S., Bolinger, B., Krebs, P., Onder, L., Miller, S., Ludewig, B.
(2009). Immunopathological Basis of Lymphocytic Choriomeningitis Virus-Induced Chorioretinitis and Keratitis. J. Virol.
83: 159-166
[Abstract][Full Text]
Ceianu, C., Tatulescu, D., Muntean, M., Molnar, G. B., Emmerich, P., Gunther, S., Schmidt-Chanasit, J.
(2008). Lymphocytic Choriomeningitis in a Pet Store Worker in Romania. CVI
15: 1749-1749
[Full Text]
Allander, T., de Lamballerie, X., Simmonds, P., Lipkin, W. I., Catton, M., Zaki, S. R.
(2008). A New Arenavirus in Transplantation. NEJM
358: 2638-2639
[Full Text]
Fishman, J. A., Gonzalez, R. G., Branda, J. A.
(2008). Case 11-2008 -- A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation. NEJM
358: 1604-1613
[Full Text]
Palacios, G., Druce, J., Du, L., Tran, T., Birch, C., Briese, T., Conlan, S., Quan, P.-L., Hui, J., Marshall, J., Simons, J. F., Egholm, M., Paddock, C. D., Shieh, W.-J., Goldsmith, C. S., Zaki, S. R., Catton, M., Lipkin, W. I.
(2008). A New Arenavirus in a Cluster of Fatal Transplant-Associated Diseases. NEJM
358: 991-998
[Abstract][Full Text]
Rojek, J. M., Perez, M., Kunz, S.
(2008). Cellular Entry of Lymphocytic Choriomeningitis Virus. J. Virol.
82: 1505-1517
[Abstract][Full Text]
Iannacone, M., Sitia, G., Isogawa, M., Whitmire, J. K., Marchese, P., Chisari, F. V., Ruggeri, Z. M., Guidotti, L. G.
(2008). Platelets prevent IFN-{alpha}/ -induced lethal hemorrhage promoting CTL-dependent clearance of lymphocytic choriomeningitis virus. Proc. Natl. Acad. Sci. USA
105: 629-634
[Abstract][Full Text]
Fishman, J. A.
(2007). Infection in Solid-Organ Transplant Recipients. NEJM
357: 2601-2614
[Full Text]
Martinez-Sobrido, L., Giannakas, P., Cubitt, B., Garcia-Sastre, A., de la Torre, J. C.
(2007). Differential Inhibition of Type I Interferon Induction by Arenavirus Nucleoproteins. J. Virol.
81: 12696-12703
[Abstract][Full Text]
Koehn, B. H., Williams, M. A., Borom, K., Gangappa, S., Pearson, T. C., Ahmed, R., Larsen, C. P.
(2007). Fully MHC-Disparate Mixed Hemopoietic Chimeras Show Specific Defects in the Control of Chronic Viral Infections. J. Immunol.
179: 2616-2626
[Abstract][Full Text]
Rojek, J. M., Spiropoulou, C. F., Campbell, K. P., Kunz, S.
(2007). Old World and Clade C New World Arenaviruses Mimic the Molecular Mechanism of Receptor Recognition Used by {alpha}-Dystroglycan's Host-Derived Ligands. J. Virol.
81: 5685-5695
[Abstract][Full Text]
Abdullah, Z., Saric, T., Kashkar, H., Baschuk, N., Yazdanpanah, B., Fleischmann, B. K., Hescheler, J., Kronke, M., Utermohlen, O.
(2007). Serpin-6 Expression Protects Embryonic Stem Cells from Lysis by Antigen-Specific CTL. J. Immunol.
178: 3390-3399
[Abstract][Full Text]
Botten, J., Whitton, J. L., Barrowman, P., Sidney, J., Whitmire, J. K., Alexander, J., Ting, J. P. C., Bui, H.-H., Sette, A., Buchmeier, M. J.
(2007). HLA-A2-Restricted Protection against Lethal Lymphocytic Choriomeningitis. J. Virol.
81: 2307-2317
[Abstract][Full Text]
Bergthaler, A., Merkler, D., Horvath, E., Bestmann, L., Pinschewer, D. D.
(2007). Contributions of the lymphocytic choriomeningitis virus glycoprotein and polymerase to strain-specific differences in murine liver pathogenicity. J. Gen. Virol.
88: 592-603
[Abstract][Full Text]
Barton, L. L., Sauter, C., Sauter, B. V., Peters, C.J.
(2006). LCMV Transmission by Organ Transplantation. NEJM
355: 1737-1738
[Full Text]
Charrel, R. N., Retornaz, K., Emonet, S., Noel, G., Chaumoitre, K., Minodier, P., Girard, N., Garnier, J.-M., de Lamballerie, X.
(2006). Acquired hydrocephalus caused by a variant lymphocytic choriomeningitis virus.. Arch Intern Med
166: 2044-2046
[Full Text]
(2006). Yet Another Infection via Organ Transplant. JWatch Infect. Diseases
2006: 6-6
[Full Text]
Previous
