Transmission of rabies virus from an organ donor to four transplant recipients.
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.
Srinivasan
Arjun
A
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, and the Epidemic Intelligence Service Branch, Centers for Disease Control and Prevention, Atlanta, USA.
Burton
Elizabeth C
EC
Kuehnert
Matthew J
MJ
Rupprecht
Charles
C
Sutker
William L
WL
Ksiazek
Thomas G
TG
Paddock
Christopher D
CD
Guarner
Jeannette
J
Shieh
Wun-Ju
WJ
Goldsmith
Cynthia
C
Hanlon
Cathleen A
CA
Zoretic
James
J
Fischbach
Bernard
B
Niezgoda
Michael
M
El-Feky
Waleed H
WH
Orciari
Lillian
L
Sanchez
Edmund Q
EQ
Likos
Anna
A
Klintmalm
Goran B
GB
Cardo
Denise
D
LeDuc
James
J
Chamberland
Mary E
ME
Jernigan
Daniel B
DB
Zaki
Sherif R
SR
D000914:Antibodies, Viral / Q000097:blood; D001921:Brain / Q000473:pathology / Q000648:ultrastructure / Q000821:virology; D002490:Central Nervous System / Q000821:virology; D018562:Disease Transmission, Infectious; D018792:Encephalitis, Viral / Q000821:virology*; D006801:Humans; D007083:Iliac Artery / Q000637:transplantation*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011818:Rabies / Q000635:transmission* / Q000821:virology; D011820:Rabies virus / Q000276:immunology / Q000302:isolation & purification*; D013345:Subarachnoid Hemorrhage; D014019:Tissue Donors; D016378:Tissue Transplantation / Q000009:adverse effects; D014771:Virion / Q000302:isolation & purification
D000914:Antibodies, Viral