Ready to upload
Adverse Occurrence type:
This reported cluster is the fifth LCMV organ transplant associated cluster documented in the United States, with 14 LCMV-infected organ recipients (2013).
Time to detection:
18 - 22 days
Alerting signals, symptoms, evidence of occurrence:
Fever, abdominal pain, diarrhea, altered mental status, and respiratory compromise.
Demonstration of imputability or root cause:
The donor, a 49 year old man developed headache and vomiting and was found to have a large intracerebral hemorrhage. Four recipients received donated organs or tissues. Liver, left kidney and right kidney recipient developed symptoms between 18 to 22 days post translant, which included fever, abdominal pain, altered mental status and respiratory compromise. They had detectable virus-specific immunoglobulin M and positive LCMV RNA in tissue or blood reverse transcription polymerase chain reaction (RT-PCR). Cornea recipient remained asymptomatic and tested negative for LCMV. LCMV was detected in donor aortic endothelial cells by RT-PCR. No definitive evidence of rodent exposure was discovered for the donor, although he had spent much time outside along the Mississippi River. Liver recipient died. One kidney graft was lost and the other kidney recipient recovered, with minor neurological sequelae. All received ribarin and had their imunosuppression decreased.
Notes from the field: a cluster of lymphocytic choriomeningitis virus infections transmitted through organ transplantation-Iowa, 2013.
Suggest new keywords:
RT PCR (reverse transcription polymerase chain reaction)
Notes from the field: a cluster of lymphocytic choriomeningitis virus infections transmitted through organ transplantation-Iowa, 2013. MMWR Morb Mortal Wkly Rep March 21, 2014/14(6);249
Expert comments for publication:
It is not feasible to proactively screen donors, it should be on the differential diagnosis in solid organ transplant recipients who develop an encephalitis syndrome within 2-3 weeks of transplantation, particularly in donors who died of intracerebral hemorrhage. Archived donor tissue samples are important to help determine imputability given that archived blood specimens have often tested negative in other SOT transmission cases. LCMV was isolated by PCR and viral culture in archived aorta tissue from a SOT and tissue donor; while the implications for tissue transplantation are unclear it is important to promptly notify tissue banks when SOT recipients develop LCMV.