Transmission of lymphocytic choriomeningitis virus by organ transplantation.
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.
Fischer
Staci A
SA
Rhode Island Hospital and Brown Medical School, Providence, USA.
Graham
Mary Beth
MB
Kuehnert
Matthew J
MJ
Kotton
Camille N
CN
Srinivasan
Arjun
A
Marty
Francisco M
FM
Comer
James A
JA
Guarner
Jeannette
J
Paddock
Christopher D
CD
DeMeo
Dawn L
DL
Shieh
Wun-Ju
WJ
Erickson
Bobbie R
BR
Bandy
Utpala
U
DeMaria
Alfred
A
Davis
Jeffrey P
JP
Delmonico
Francis L
FL
Pavlin
Boris
B
Likos
Anna
A
Vincent
Martin J
MJ
Sealy
Tara K
TK
Goldsmith
Cynthia S
CS
Jernigan
Daniel B
DB
Rollin
Pierre E
PE
Packard
Michelle M
MM
Patel
Mitesh
M
Rowland
Courtney
C
Helfand
Rita F
RF
Nichol
Stuart T
ST
Fishman
Jay A
JA
Ksiazek
Thomas
T
Zaki
Sherif R
SR
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