In 2004, 4 recipients of kidneys, a liver, and an arterial segment from a common organ donor died of encephalitis of an unknown cause.
Dr Srinivasan and colleagues reviewed the medical records of the organ donor and the recipients.
The research team tested blood, cerebrospinal fluid, and tissues from the recipients with a variety of assays and pathological stains for numerous causes of encephalitis.
Samples from the recipients were also inoculated into mice.
The team noted that the organ donor had been healthy before having a subarachnoid hemorrhage that led to his death.
The investigators reported that encephalitis developed in all 4 recipients within 30 days after transplantation and was accompanied by rapid neurologic deterioration characterized by agitated delirium, seizures, respiratory failure, and coma.
|Antibodies against rabies virus were present in 3 of the 4 recipients|
|New England Journal of Medicine|
The patients died an average of 13 days after the onset of neurologic symptoms.
In addition, the investigative team reported that mice inoculated with samples from the affected patients became ill 7 to 8 days later, and electron microscopy of central nervous system tissue demonstrated rhabdovirus particles.
Rabies-specific immunohistochemical and direct fluorescence antibody staining demonstrated rabies virus in multiple tissues from all recipients.
The researchers showed that cytoplasmic inclusions were consistent with Negri bodies seen in central nervous system tissue from all recipients.
The team concluded that antibodies against rabies virus were present in three of the four recipients and the donor and noted that the donor had told others of being bitten by a bat.
Dr Srinivasan concludes, “This report documenting the transmission of rabies virus from an organ donor to multiple recipients underscores the challenges of preventing and detecting transmission of unusual pathogens through transplantation.”