Record number: 
Adverse Occurrence type: 
MPHO 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.
Imputability grade: 
3 Definite/Certain/Proven
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