Status:
Ready to upload
Record number:
2100
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Very rare. Considering the existence of asymptomatic cases but low number of infections in the population (between 2006 and 2016 in the US, there were 99 cases of POWV disease reported during the 11-year period, including 89 neuroinvasive and 10 nonneuroinvasive disease cases. There was a median of seven cases per year (range: 1-22), with the highest numbers of cases reported in 2011 (n = 16), 2013 (n = 15), and 2016 (n = 22), therefore, the risk of transfusion transmitted POWV is estimated as low.
Time to detection:
Symptom onset in kidney transplant recipient 24 days after transplantation (22 days after the implicated blood transfusion) and the anti-POWV IgM detected in patient 13 days after symptom onset (37 days after transplantation/ 35 days after the implicated blood transfusion).
Alerting signals, symptoms, evidence of occurrence:
The patient, a woman in her thirties, developed severe frontal headache, fever, weakness, myalgias, and diarrhoea 24 days after kidney transplantation. Thirty-three days after transplantation, she was admitted to her transplant centre in Wisconsin with fever, headache, chills, confusion, photophobia, nausea, and diarrhoea. Between the third and fourth hospital days, she developed tremors, ataxia, dysarthria, sensorineural hearing loss, and bilateral blurred vision. Brain MRI on the third hospital day demonstrated a new loss of CSF suppression and diffuse pial enhancement in the cerebellum. Thirteen days after symptom onset, Powassan virus-specific IgM antibodies were detected in serum and CSF.
Demonstration of imputability or root cause:
The lung transplant recipient from the same donor whose kidney was transplanted to the case patient did not develop illness and there was no laboratory evidence of POWV infection in the lung recipient as well as in the donor archive sample. This excluded the organ donor as the likeliest source of infection.
Pretransplant samples of the involved patient were negative serologically for POWV and ticks transmitting POWV were not present in the living place of the patient. The patient received red blood cells (RBC) from 3 different donors. The donor whose RBCs were transfused the second day post-transplantation was working in the woods and plasma separated from donated whole blood was positive for POWV RNA and 6 months later that donor was POWV IgM and NeuAb positive. The other two donors were laboratory negative. This indicates probable blood transfusion associated transmission.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest new keywords:
Powassan virus
Organ recipient
transfusion transmitted
encephalitis
meningoencephalitis
Reference attachment:
Suggest references:
Taylor L et al. Powassan virus infection likely acquired through blood transfusion presenting as encephalitis in a kidney transplant recipient. Clin Infect Dis. 2020 Jun 15;ciaa738.
Kapoor AK, Zash R. Powassan Virus. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570599/
Note:
Add Powassan virus in the viral taxonomy - done (EP)
Expert comments for publication:
Powassan virus (POWV) is an endemic tick-borne Flavivirus that causes encephalitis and meningoencephalitis. POWV is found in the Northeastern United States, Canada, and Russia. (Ref: https://www.ncbi.nlm.nih.gov/books/NBK570599/). When evaluating organ transplant recipients with infection related symptoms, investigation should also consider blood donors of the recipient or the organ donor as a possible sources of infection.