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Adverse Occurrence type:
All four recipients from a common donor were infected; 2 died of neuro-invasive WNV disease and two had mild symptoms.
Time to detection:
10 - 17 days
Alerting signals, symptoms, evidence of occurrence:
Fever, myalgia, dyspnea, lethargy, diarrhea, headache, disorientation, left sided weakness, encephalopathy, coma. The adult male donor had a history of cerebral palsy, seizures, and blindness. In late summer of 2011, he had acute onset of fever and lethargy and was diagnosed with a urinary tract infection. He suffered cardiopulmonary arrest the following day and went to donate organs and tissues. No tissues were used, Eight weeks after the donor’s death, cryopreserved skin sample, fat, muscle, tendon, and bone ( stored frozen at -70°C) tested positive for WNV RNA by PCR. Virus as only recovered in tissue culture from lymphoid tissue homogenate.
Demonstration of imputability or root cause:
Common donor residing in a region of increased WNV activity. Donor investigated retrospectively and found to be WNV IgM and IgG positive and WNV RNA negative in serum but positive in lympho reticular tissue. All four transplant recipients had molecular evidence of WNV infection in their serum and/or cerebrospinal fluid (CSF) by reverse transcription polymerase chain reaction (RT-PCR) testing. One kidney recipient and lung recipient died of WNV encephalitis, the other kidney recipient and liver recipient had mild non-specific symptoms and recovered. All four received polyvalent human intravenous immunoglobulin.
Donor-Derived West Nile Virus Infection in Solid Organ Transplant Recipients: Report of Four Additional Cases and Review of Clinical, Diagnostic, and Therapeutic Features.
Suggest new keywords:
RT PCR (reverse transcription polymerase chain reaction)
Winston, et al 2014. Donor-Derived West Nile Virus Infection in Solid Organ Transplant Recipients: Report of Four Additional Cases and Review of Clinical,Diagnostic, and Therapeutic Features. Transplantation. 15 May 2014 - Volume 97 - Issue 9 - p 881-889
Expert comments for publication:
Inability to detect viral RNA in plasma does not exclude risk of transmission through solid organ donation; several cases of proven donor-derived WNV infections are known to have occurred, where there was clinical and or serological evidence of recent WNV infection. Difficulties in noting and diagnosing a potential CNS infectious process, due to confounding factors, but due consideration must be given during donor characterization