Reuters Health Information (2005-03-16): Fatal rabies cases following organ transplantation described
Fatal rabies cases following organ transplantation described
Last Updated: 2005-03-16 17:00:08 -0400 (Reuters Health)
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
N Engl J Med 2005;352:1103-1111.