Adverse Occurrence type:
Alerting signals, symptoms, evidence of occurrence:
Early symptoms include malaise, redness, itching, swelling and intense pain in the operated eye and retro-orbital headache radiating to the neck. Progressive symptoms include: paresthesia or hypesthesia of the face; facial asymmetry; dehydration and hydrophobia; difficulty swallowing; tongue and palatal weakness photophobia; Hypersalivation; diffuse myalgias; paresthesias to the hands and lower limbs; loss of deep tendon reflexes and difficulty walking; progressive flaccid paralysis; delirium; encephalitis; progressive respiratory distress; coma; death. Cornea Recip 1(Iran): Onset Day 26: nausea, lip paresthesia, day 27 hydrophobia, Cornea Recip 2 (Iran): Onset day 40: vomiting, weakness (Iran)
Demonstration of imputability or root cause:
Definite. Donors died with rabies. Temporal association of recipient’s illness, lack of other rabies exposure, and retro-orbital pain in the eye that received the corneal transplant support the diagnosis of transplant-acquired rabies. Pain, paresthesia, or hypesthesia at the site of virus inoculation is a classic symptom of rabies. Postmortem diagnosis includes identifying Negri bodies in brain or eye tissue, isolating virus in eye tissue, or using immunofluorescent techniques to demonstrate rabies antigen.
Management and outcomes after multiple corneal and solid organ transplantations from a donor infected with rabies virus