title: West Nile virus transmission through organ transplantation in north-eastern Italy: a case report and implications for pre-procurement screening.
abstract: OBJECTIVE
  West Nile virus (WNV) transmission through organ transplantation occurs rarely and screening of organ donors for WNV infection remains controversial. This report describes the case of WNV encephalitis in a kidney recipient and the case of asymptomatic WNV infection in the organ donor, both observed at Treviso Hospital, northeastern Italy. After briefly reviewing the literature, we discuss the implications for WNV screening.
  
  
  METHODS
  We reviewed medical, laboratory and epidemiological records at our hospital, and the literature concerning cases of organ-transmitted WNV infections and WNV screening of organ donors in Italy and worldwide.
  
  
  RESULTS
  The kidney recipient was the first confirmed case of WNV infection notified in northeastern Italy in 2011, and the first case of WNV infection in a cluster of four transplant recipients who acquired the infection from a common organ donor. The organ donor, whose WNV infection was only retrospectively diagnosed by IgM detection, represents the index case of a WNV outbreak in the Treviso Province. Screening of her blood prior to organ recovery did not show detectable levels of WNV nucleic acid with the use of quantitative real-time polymerase chain reaction.
  
  
  CONCLUSIONS
  This report emphasizes that transplant-acquired WNV neuroinvasive disease can be particularly severe. We suggest that pre-procurement screening of organ donors by testing blood with both WNV IgM capture ELISA and a sensitive nucleic acid testing should be adopted during the transmission season in the present Italian epidemiological setting.
authors.affiliation: Treviso Hospital, Treviso, Italy. inojosawalter@hotmail.com
authors.forename: W O
authors.initials: WO
authors.lastname: Inojosa
authors.forename: P G
authors.initials: PG
authors.lastname: Scotton
authors.forename: R
authors.initials: R
authors.lastname: Fuser
authors.forename: M
authors.initials: M
authors.lastname: Giobbia
authors.forename: A
authors.initials: A
authors.lastname: Paolin
authors.forename: M C
authors.initials: MC
authors.lastname: Maresca
authors.forename: A
authors.initials: A
authors.lastname: Brunello
authors.forename: E
authors.initials: E
authors.lastname: Nascimben
authors.forename: C
authors.initials: C
authors.lastname: Sorbara
authors.forename: R
authors.initials: R
authors.lastname: Rigoli
authors.forename: R
authors.initials: R
authors.lastname: Berti
authors.forename: G B
authors.initials: GB
authors.lastname: Gajo
authors.forename: B
authors.initials: B
authors.lastname: Giometto
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003128:Coma / Q000821:virology; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D012367:RNA, Viral / Q000097:blood; D014019:Tissue Donors; D014180:Transplantation; D019737:Transplants / Q000009:adverse effects* / Q000821:virology; D014901:West Nile Fever / Q000175:diagnosis / Q000635:transmission* / Q000821:virology; D014902:West Nile virus / Q000302:isolation & purification*
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral