title: Transmission of lymphocytic choriomeningitis virus by organ transplantation.
abstract: BACKGROUND
  In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were unrevealing, and in each a common donor was recognized.
  
  
  METHODS
  We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histopathological examination with immunohistochemical staining to identify a cause. Epidemiologic investigations, including interviews, environmental assessments, and medical-record reviews, were performed to characterize clinical courses and to determine the cause of the illnesses.
  
  
  RESULTS
  Laboratory testing revealed lymphocytic choriomeningitis virus (LCMV) in all the recipients, with a single, unique strain of LCMV identified in each cluster. In both investigations, LCMV could not be detected in the organ donor. In the 2005 cluster, the donor had had contact in her home with a pet hamster infected with an LCMV strain identical to that detected in the organ recipients; no source of LCMV infection was found in the 2003 cluster. The transplant recipients had abdominal pain, altered mental status, thrombocytopenia, elevated aminotransferase levels, coagulopathy, graft dysfunction, and either fever or leukocytosis within three weeks after transplantation. Diarrhea, peri-incisional rash, renal failure, and seizures were variably present. Seven of the eight recipients died, 9 to 76 days after transplantation. One recipient, who received ribavirin and reduced levels of immunosuppressive therapy, survived.
  
  
  CONCLUSIONS
  We document two clusters of LCMV infection transmitted through organ transplantation.
authors.affiliation: Rhode Island Hospital and Brown Medical School, Providence, USA.
authors.forename: Staci A
authors.initials: SA
authors.lastname: Fischer
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Graham
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kuehnert
authors.forename: Camille N
authors.initials: CN
authors.lastname: Kotton
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Marty
authors.forename: James A
authors.initials: JA
authors.lastname: Comer
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guarner
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.forename: Dawn L
authors.initials: DL
authors.lastname: DeMeo
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Bobbie R
authors.initials: BR
authors.lastname: Erickson
authors.forename: Utpala
authors.initials: U
authors.lastname: Bandy
authors.forename: Alfred
authors.initials: A
authors.lastname: DeMaria
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Davis
authors.forename: Francis L
authors.initials: FL
authors.lastname: Delmonico
authors.forename: Boris
authors.initials: B
authors.lastname: Pavlin
authors.forename: Anna
authors.initials: A
authors.lastname: Likos
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Vincent
authors.forename: Tara K
authors.initials: TK
authors.lastname: Sealy
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Goldsmith
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jernigan
authors.forename: Pierre E
authors.initials: PE
authors.lastname: Rollin
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Packard
authors.forename: Mitesh
authors.initials: M
authors.lastname: Patel
authors.forename: Courtney
authors.initials: C
authors.lastname: Rowland
authors.forename: Rita F
authors.initials: RF
authors.lastname: Helfand
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Nichol
authors.forename: Jay A
authors.initials: JA
authors.lastname: Fishman
authors.forename: Thomas
authors.initials: T
authors.lastname: Ksiazek
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D000328:Adult; D000818:Animals; D001117:Arenaviridae Infections / Q000662:veterinary; D006224:Cricetinae; D018562:Disease Transmission, Infectious; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000821:virology; D008099:Liver / Q000473:pathology / Q000821:virology; D008168:Lung / Q000473:pathology / Q000821:virology; D008216:Lymphocytic Choriomeningitis / Q000635:transmission*; D008217:Lymphocytic choriomeningitis virus / Q000145:classification / Q000302:isolation & purification* / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D015047:Zoonoses / Q000635:transmission