Status:
Ready to upload
Record number:
1964
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
EEEV has been found in North and South America. While its activity has increased over the past two decades, it is still uncommon (an average of approx 11 cases/year reported in the US)--the primary transmission cycle occurs in and around freshwater hardwood swamps. EEE is maintained in an enzootic cycle between ornithophilic mosquitoes and birds. The virus causes disease in some avian and incidental hosts, such as horses and humans; the case-fatality rate in humans is ≈33%.
This is the first known case report of organ donor-derived EEEV infection. There are no reports of transfusion-transmitted EEEV.
Time to detection:
Symptom onset occurred within 6-7 days of transplant for all three recipients. Diagnosis was made at day 8 or 9 via CSF positive for EEEV IgM.
Alerting signals, symptoms, evidence of occurrence:
Recipients developed abrupt onset headache and persistent fevers. They also developed progressive altered mental status.
In addition to positive EEEV IgM in the CSF, all three recipients had a pleocytosis in the CSF. Two of the three recipients also had EEEV RNA tested from the CSF and both were negative. Imaging via Brain MRI showed abnormalities that varied across recipients, but most notably they were all abnormal with one having patchy T2-weighted and fluid-attenuated inversion recovery (T2/FLAIR) signal abnormality and edema, another having nonenhancing lesions with restricted diffusion, and the third having multi-focal signals, with additional areas concerning for meningoencephalitis on T2/FLAIR images. The areas of the brain also varied across all three recipients.
The heart transplant recipient also developed myonecrosis found during routine post-transplant biopsy.
Demonstration of imputability or root cause:
Transmission was demonstrated by showing the recipient having detectable EEEV via PCR, and recipients seroconverting from EEEV IgM negative to EEEV IgG positive. However, there are no data on the presence of infection in organ recipients before transplantation.
Imputability grade:
2 Probable
Groups audience:
Keywords:
References:
Suggest new keywords:
Altered Mental Status
Neuroinvasive disease
Reference attachment:
Suggest references:
1) Pouch SM, et al. Transmission of Eastern Equine Encephalitis Virus from an Organ Donor to Three Transplant Recipient. Clin Infect Dis. 2018 Oct 29
2) Armstrong PM, Andreadis TG. Ecology and Epidemiology of Eastern Equine Encephalitis Virus in the Northeastern United States: An Historical Perspective. J Med Entomol. 2022 Jan 12;59(1):1-13
Note:
MG Note: I added some useful epidemiological information about EEE can be found...I am not sure if the report didn't talk about the donor or if it wasn't included, but I would imagine the donor must have died of undiagnosed EEE, and if so it would be good to add some information about looking back at the donor if a recipient has headache and mental status changes. Also please look at the imputability and ensure whether you agree or if it needs to be downgraded (which I suspect will be the case).
https://www.cdc.gov/eastern-equine-encephalitis/data-maps/
Add new AO type for EEEV (Done_EP)
Expert comments for publication:
EEEV transmission appears to be rare as this is the first reported case of donor derived infection. However, it caused severe neuroinvasive disease in all three recipients, with two recipients dying as a result. Donor derived EEEV should be considered for recipients who developed profound altered mental status during periods where mosquitos are very active in an epidemologically plausible environment.