Public Health

Fatal rabies cases following organ transplantation described

Last Updated: 2005-03-16 17:00:08 -0400 (Reuters Health)

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - The March 17 issue of The New England Journal of Medicine carries a paper describing the previously reported occurrence of fatal rabies infections in recipients of organs and tissue from a single infected donor, marking the first time rabies has been spread through solid organ donation.

This outbreak was first reported by the Centers for Disease Control and Prevention last July (see Reuters Health report July 1, 2004). The current update includes the discovery of a fourth patient -- in addition to the three originally reported -- who acquired the infection after receiving a vascular graft from the index donor.

"This has never happened before," Dr. Mitchell Cohen, director of the coordinating center for infectious diseases at the CDC, told reporters at a media briefing last year. "Human rabies is very rare -- we see only a few human cases each year and it is usually in people who have been bitten or scratched by bats. The risk of healthcare-associated transmission is considered to be extremely low."

Although there have been reports of rabies transmission through cornea transplants, this is the first report of transmission from solid organ transplantation, according to the CDC.

The rabies infections originated from a previously healthy male Arkansas resident who presented to an emergency room in Texas with mental status changes and fever. Neuroimaging revealed a brain hemorrhage and the patient died 48 hours later.

Routine donor eligibility testing revealed no contraindications to transplantation and the family gave consent for donation. Rabies testing is not currently part of the screening procedure.

The donor's kidneys, liver, and an arterial segment were transplanted into four patients in May 2004. The patients were hospitalized with symptoms including hypotension, seizures, and lethargy within 30 days of transplantation, and all four died an average of 13 days after onset of neurological symptoms.

A series of tests were performed on the recipients and the CDC confirmed that all four were infected with a strain of rabies commonly found in bats. Prior to his death, the donor had apparently told his friends of being bitten by a bat.

"This rabies outbreak was really picked up because you had patients who were in close proximity within the same healthcare system," Dr. Arjun Srinivasan, lead author of the current report, told Reuters Health. "The same physician saw more than one of these patients and was able to put things together."

"Improving dialog between centers or even across states, through the organ procurement organizations, may go a long way toward detecting these sorts of clusters sooner," Dr. Srinivasan, from the Atlanta-based CDC, added.

N Engl J Med 2005;352:1103-1111.