Record number:
956
Adverse Occurrence type:
MPHO Type:
Time to detection:
18 months
Alerting signals, symptoms, evidence of occurrence:
Hip pain with radiation to leg, ascending paraesthesia and weakness, encephalopathy, excessive salivation, and hemodynamic instability.
Demonstration of imputability or root cause:
Definite; raccoon rabies virus variant infecting donor and deceased kidney recipient >99.9% identical by sequencing. This is the only recipient (1 out of four) of organ from the common donor who developed symptoms: liver recipient as well as right kidney and heart recipients had not been previously immunized against rabies and received post exposure prophylaxis that consisted of rabies hyper immunoglobulin and five doses of rabies vaccine (IWDT). This was 18 months post transplant as the left kidney recipient developed and died of proven donor-derived rabies at 17 months post-transplant.
This is the first report where unvaccinated graft recipients did not develop rabies disease; the latency period of 17 months in the only recipient of organs from the same donor (out of 4) who was infected and died of rabies is also the longest reported.
Imputability grade:
3 Definite/Certain/Proven
Keywords:
References:
Suggest references:
Vora NM, et al. Raccoon Rabies Virus Variant Transmission Through Solid Organ Transplantation. JAMA 2013;310(4):398-407.
Expert comments for publication:
Rabies raccoon variant had been reported to infect only one person previously. It is hypothesised that Infection with this variant may have been the explanation for the prolonged incubation period when compared to canine and bat lyssaviruses. It may also have explained the outcome in the 3 recipients described here. The role of post exposure prophylaxis ought to be noted.