Report documents organ transplantation as source of fatal rabies virus case

July 23, 2013, The JAMA Network Journals

An investigation into the source of a fatal case of raccoon rabies virus exposure indicates the individual received the virus via a kidney transplant 18 months earlier, findings suggesting that rabies transmitted by this route may have a long incubation period, and that although solid organ transplant transmission of infectious encephalitis is rare, further education to increase awareness is needed, according to a study in the July 24/31 issue of JAMA.

The rabies virus causes a fatal (inflammation of the brain) and can be transmitted through tissue or organ transplantation. "Unique rabies virus variants, distinguishable by molecular typing methods, are associated with specific animal reservoirs. Globally, an estimated 55,000 persons die of rabies every year, with most transmission attributable to dog bites. Approximately 2 human rabies deaths are reported in the United States every year and during 2000 through 2010, all but 2 domestically acquired cases were associated with bats. Despite being the most frequently reported rabid animal in the United States, only l human rabies case associated with the raccoon rabies virus variant has been reported," according to background information in the article. In February 2013, a kidney recipient with no reported exposures to potentially rabid animals died from rabies 18 months after transplantation.

Neil M. Vora, M.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to determine whether organ transplantation was the source of rabies virus exposure in the kidney recipient, and to evaluate for and prevent rabies in other transplant recipients (n = 3; right kidney, heart, and liver) from the same donor. Organ donor and all transplant recipient medical records were reviewed. Laboratory tests to detect rabies virus-specific binding antibodies, rabies virus neutralizing antibodies, and rabies virus antigens were conducted on available specimens, including serum, cerebrospinal fluid, and tissues from the donor and the recipients.

The researchers found that in retrospect, the kidney donor's symptoms prior to death were consistent with rabies (the presumed diagnosis at the time of death was ciguatera poisoning [a foodborne illness]). Subsequent interviews with family members revealed that the donor had significant wildlife exposure, and had sustained at least 2 raccoon bites, for which he did not seek medical care. Rabies virus antigen was detected in archived autopsy brain tissue collected from the donor. The rabies viruses infecting the donor and the deceased kidney recipient were consistent with the raccoon rabies virus variant and were more than 99.9 percent identical across the entire N gene, thus confirming organ transplantation as the route of transmission.

The 3 other organ recipients did not have signs or symptoms consistent with rabies or encephalitis. They have remained asymptomatic, with neutralizing antibodies detected in their serum after completion of postexposure prophylaxis.

"This transmission event provides an opportunity for enhancing rabies awareness and recognition and highlights the need for a modified approach to organ donor screening and recipient monitoring for infectious encephalitis. This investigation also underscores the importance of collaboration between clinicians, epidemiologists, and laboratory scientists," the authors write.

Explore further: US organ transplant patient dies of rabies

More information: JAMA. 2013;310(4):398-407

Related Stories

US organ transplant patient dies of rabies

March 15, 2013
A person in the northeastern state of Maryland who recently died of rabies was found to have contracted the illness from an organ transplant done over a year ago, US health officials said Friday.

CDC: Rabies no longer threat to three organ recipients

April 2, 2013
Federal public health officials say three people who received organs from a rabies-infected donor in 2011 are no longer in danger of coming down with the deadly disease.

Hundreds checked for rabies after transplant death

March 17, 2013
Public health agencies in five U.S. states are assessing the rabies risk for hundreds of people who may have had close contact with an infected organ donor and four transplant recipients, one of whom died, officials said ...

Fla. company supplied organs in rabies case

March 18, 2013
(AP)—An official at an organ donation service in Florida says it was the supplier of transplanted organs from a man who later was found to have died of rabies.

Bat on Wisconsin flight prompts rabies probe

August 12, 2011
(AP) -- Health officials say a bat on a flight from Wisconsin to Atlanta last week has sparked a national search for passengers to protect them against possible rabies.

Recommended for you

Best of Last Year—The top Medical Xpress articles of 2017

December 20, 2017
It was a good year for medical research as a team at the German center for Neurodegenerative Diseases, Magdeburg, found that dancing can reverse the signs of aging in the brain. Any exercise helps, the team found, but dancing ...

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.