The rabies virus causes a fatal encephalitis (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 raccoons 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 rabies virus 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.
Source: American Medical Association