Organ Transplant Recipient Died Of Rabies, CDC Confirms

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Main Category: Transplants / Organ Donations
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 15 Mar 2013 - 12:00 PDT


A transplant organ recipient died of rabies in Maryland, the CDC announced. It also confirmed that the patient had contracted the infection through the transplantation which occurred over one year ago.

Three other patients had received organs from the same donor. The CDC says they have been contacted and are getting their rabies vaccinations.

Tissue samples from the donor and the recipient were tested at CDC laboratories to confirm that the infection came from the donated organ.

The patient's death, in early March 2012, triggered an investigation by the Maryland Department of Health and Mental Hygiene. An autopsy confirmed that the organ recipient had rabies and no exposure to animals, the main source of transmission of the disease to humans. Experts identified the possibility of transplant-related transmission of rabies, an extremely rare occurrence.

There was a lapse of over 12 months between receiving the organ transplant and becoming ill with rabies. This is a very long time - the incubation for rabies is from one to three months. However, there have been cases of much longer incubation periods.

Preliminary analysis at the CDC (Centers for Disease Control and Prevention) labs indicated that both the recipient and donor had the same kind of raccoon-type rabies virus. The virus can also infect other domestic and wild animals. There is only one other reported death from a raccoon-type rabies virus in the USA.

The donor became ill in 2011 and was admitted to a hospital in Florida, where he died. His heart, liver and kidneys were recovered and delivered to recipients in Florida, Maryland, Illinois and Georgia. Doctors had not considered rabies as the donor's cause of death at that time; this was confirmed much later, after the recipient in Maryland died.

The donor, a resident of North Carolina, had become ill shortly after moving to Florida. The CDC and Maryland Authorities believe his exposure to animals occurred before he moved to Florida. The CDC is currently trying to find out exactly how the donor got rabies.

In a communiqué, the CDC says that the three other organ recipients are currently being evaluated by doctors and receiving the immune globulin and anti-rabies vaccination. The CDC is collaborating closely with health authorities in North Carolina, Illinois, Georgia, Florida and Maryland to identify anybody who may have been in close contact with the initial donor or the four organ recipients.

According to the CDC, all organ donors in the USA are tested and screened to determine whether they might pose an infection risk. It is the responsibility of the organ procurement organization to evaluate the suitability of each donor. When deciding whether an organ donor is eligible, they:

• Ask the family and close contacts a series of questions
• Carry out a physical examination
• Test for infectious diseases, including HIV and hepatitis.

In a typical year, there are between 1 and 3 human cases of rabies reported to US health authorities. Laboratory testing of donors for rabies is not carried out routinely if the disease is not clinically suspected, because it would take too long and the organs destined for transplantation would no longer be viable (rabies test results take too long).

The CDC says that the benefits of transplanted organs outweigh the risk of getting infectious diseases from screened donors.

Transplanted organ recipients infected with rabies before in USA

In 2004, the CDC confirmed that three recipients of transplanted organs and their common donor were infected with rabies.

The organ recipients developed encephalitis (of unknown etiology) after the transplant operations and subsequently died.

Tissue samples were taken and sent to CDC labs for testing, which confirmed rabies infection in all three recipients.

About rabies

Rabies, a preventable viral disease of animals, is typically transmitted to humans (Zoonotic) via the bite of an infected (rabid) animal. In very rare cases, humans have been infected by breathing in contaminated air in bat caves. The deadly virus attacks the central nervous system, causing acute encephalitis.

In virtually all cases, rabies is fatal. There is a chance of survival if the patient is treated before the onset of symptoms.

Infected individuals who do not receive preventive treatment (post-exposure prophylaxis) will develop a fever, muscle pains (myalgia) and headache. This eventually progresses to brain inflammation, confusion, seizures, paralysis, coma and death.

Rabies is incurable as soon as the virus reaches the nerves. Any suspicious contact with animals should be promptly treated with RIG (rabies immunoglobulin) injections, rabies vaccine and antibiotics.

Symptoms become evident about four to eight weeks after initial infection (incubation period). However, incubation periods spanning from just one week to one year are possible.

According to the World Health Organization:

• 55,000+ people die from rabies annually worldwide
• The vast majority of human rabies deaths occur in Africa and Asia
• 40% of humans who are bitten from (suspect) rabid animals are under 15 years of age
• Most humans who die from rabies became infected after a dog bite (in 2007, the CDC announced that the USA was free form canine rabies)
• Thoroughly cleaning the wound and immunization within a few hours after being bitten can prevent the onset of rabies symptoms and death
• Hundreds of thousands of rabies deaths are thought to be prevented annually because of prompt post-exposure vaccinations (administered to over 15 million people annually)

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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