Transmission of rabies virus from an organ donor to four transplant recipients

TitleTransmission of rabies virus from an organ donor to four transplant recipients
Publication TypeJournal Article
Year of Publication2005
AuthorsSrinivasan A, Burton EC, Kuehnert MJ, Rupprecht C, Sutker WL, Ksiazek TG, Paddock CD, Guarner J, Shieh WJ, Goldsmith C, Hanlon CA, Zoretic J, Fischbach B, Niezgoda M, El-Feky WH, Orciari L, Sanchez EQ, Likos A, Klintmalm GB, Cardo D, LeDuc J, Chamberland ME, Jernigan DB, Zaki SR
JournalN Engl J Med
Pagination1103 - 11
Date Published42795
ISSN1533-4406 (Electronic) 0028-4793 (Linking)
Accession Number15784663
Keywords*Disease Transmission, Infectious, Antibodies, Viral / blood, Brain / pathology / ultrastructure / virology, Central Nervous System / virology, Encephalitis, Viral / *virology, Humans, Iliac Artery / *transplantation, Kidney Transplantation / *adverse effects, Liver Transplantation / *adverse effects, Male, Rabies / *transmission / virology, Rabies virus / immunology / *isolation & purification, Subarachnoid Hemorrhage, Tissue Donors, Tissue Transplantation / adverse effects, Virion / isolation & purification

BACKGROUND: In 2004, four recipients of kidneys, a liver, and an arterial segment from a common organ donor died of encephalitis of an unknown cause. METHODS: We reviewed the medical records of the organ donor and the recipients. Blood, cerebrospinal fluid, and tissues from the recipients were tested with a variety of assays and pathological stains for numerous causes of encephalitis. Samples from the recipients were also inoculated into mice. RESULTS: The organ donor had been healthy before having a subarachnoid hemorrhage that led to his death. Encephalitis developed in all four recipients within 30 days after transplantation and was accompanied by rapid neurologic deterioration characterized by agitated delirium, seizures, respiratory failure, and coma. They died an average of 13 days after the onset of neurologic symptoms. Mice inoculated with samples from the affected patients became ill seven to eight days later, and electron microscopy of central nervous system (CNS) tissue demonstrated rhabdovirus particles. Rabies-specific immunohistochemical and direct fluorescence antibody staining demonstrated rabies virus in multiple tissues from all recipients. Cytoplasmic inclusions consistent with Negri bodies were seen in CNS tissue from all recipients. Antibodies against rabies virus were present in three of the four recipients and the donor. The donor had told others of being bitten by a bat. CONCLUSIONS: This report documenting the transmission of rabies virus from an organ donor to multiple recipients underscores the challenges of preventing and detecting transmission of unusual pathogens through transplantation.

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