West Nile Virus

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Alerting signals, symptoms, evidence of occurrence: 
Liver Recipient: uneventful postoperative course, no symptoms suggestive of WNV infection after transplantation. Serum collected on posttransplantation day 52 showed no detectable WNV RNA or IgM antibodies, whereas WNV IgG antibodies were present; neutralisation Ab titres were 4-fold higher against dengue than WNV and St Louis encephalitis virus. Two additional recipients from the same organ donor were identified: the left kidney recipient died of WNV encephalitis and the right kidney recipient had prolonged but clinically inapparent WNV viremia.
Demonstration of imputability or root cause: 
The donor was not screened for WNV infection before organ retrieval; a retained serum specimen collected 3 days before organ procurement was retrospectively tested and found to be positive for WNV RNA by individual nucleic acid amplification testing (NAT). The other 2 kidney recipients from the common donor had evidence of WNV infection.
Imputability grade: 
2 Probable
Suggest new keywords: 
asymptomatic infection
Reference attachment: 
Suggest references: 
Rabe, Ingrid B.; Schwartz, Brian S.; Farnon, Eileen C.; Josephson, S. Andrew; Webber, Allison B.; Roberts, John Paul; de Mattos, Angelo M.; Gallay, Brian J.; van Slyck, Sean; Messenger, Sharon L.; Yen, Cynthia J.; Bloch, Evan M.; Drew, Clifton P.; Fischer, Marc; Glaser, Carol A (2013).Fatal Transplant-Associated West Nile Virus Encephalitis and Public Health Investigation-California, 2010. Transplantation 96(5):463-468. doi: 10.1097/TP.0b013e31829b4142.
Expert comments for publication: 
See record 955 for the description of the two kidney recipients who were viraemic for WNV. This liver recipient had demonstrable Flavivirus antibodies but there was insuffiicient serum available to determine specificity of the result; this patient remained asymptomatic, and so did the right kidney recipient. Given the details for the 3 recipients and the donor, asymptomatic infection may have occurred in this case.