Maryland rabies case came from kidney transplant, sources say

[okarol]

Maryland rabies case came from kidney transplant, sources say

By David Brown, Published: March 14

A Maryland man who two weeks ago became the state’s first fatal case of rabies in nearly 40 years contracted the infection from a kidney transplant, according to two people familiar with the case.

Three people in other states received organs from the same donor, but their conditions were not immediately known.

Victim was first in Md. to die of rabies in nearly 40 years. Three others got organs from the same donor.

The recipient died at the Veterans Affairs Medical Center in Washington after being in the hospital for about a month, according to the people with knowledge of the case, who spoke on the condition of anonymity. He had received a kidney from a Florida man in an operation at the Walter Reed National Military Medical Center in 2011.

The Centers for Disease Control and Prevention compared rabies virus obtained from the recipient and determined that it was genetically identical to the virus recovered from the organ’s donor, said the two people involved in the case.

CDC officials were expected to announce some details of the case Friday.

Untreated rabies is almost always fatal. People vaccinated after becoming infected but before symptoms develop usually survive. For that reason, finding the other people who received organs — reportedly a kidney, heart and liver — is urgent.

Transmission of rabies through organ or tissue transplant is extremely rare. Four people in Texas died in 2004 from rabies contracted from a single donor’s tissue. There have been at least eight cases around the world contracted through cornea transplants.

Investigation of the case involves county, state, federal and military epidemiologists, physicians and laboratory scientists.

Rabies was suspected shortly before the recipient’s death but was not confirmed until his brain was examined in an autopsy. The idea that he could have contracted the infection from the transplanted kidney was initially doubted because of the extremely long time — about 15 months — between the surgery and his death. The incubation of rabies cases is rarely longer than three months.

In general, fewer than five cases of rabies are diagnosed each year in the United States. Most often the virus is acquired by contact with a bat. Bites from infected raccoons and dogs, or contact with their saliva, account for most of the rest. How the Florida man may have contracted the infection could not be learned.

The virus travels up nerves to the brain, a process that takes weeks or months if the entry wound is far from the head (as in the foot). Symptoms are varied and occasionally dramatic, such as the fear of swallowing water known as hydrophobia. The patient usually slips into a coma and dies of respiratory failure.

The donor, described as a man in his 20s, died of encephalitis, a general term for inflammation of the brain. The condition has many causes. Viruses such as herpes simplex and West Nile virus are among the more common. Rabies is among the rarest.

Details of the donor’s medical care could not be learned. In particular, it was not known what tests were done and which diagnoses were considered before he died. But rabies was not diagnosed until his brain, which had been preserved, was examined after the death of the recipient in Washington.

Potential organ donors are screened for a standard battery of infectious diseases before their organs are offered. Rabies is not one of them, however.

“The decision whether to accept or reject an organ is an independent medical judgment based on the testing and information the physicians have on the potential donor,” said Joel Newman, a spokesman for the United Network for Organ Sharing, the national organization in Richmond that helps coordinate transplants.

What screening tests were done on the donor and his tissue in addition to the usual ones also could not be learned. Blood tests usually reveal antibodies to the virus, and the infection is confirmed by examining thin slices of brain tissue under a microscope. Several experts said it is unlikely that rabies could be ruled out for certain within the time window in which a transplant has to be done.

“Everyone was taken aback that someone who dies of encephalitis is considered acceptable to donate an organ,” said one person involved in the case.

Organs from people with known infections are, however, occasionally transplanted. In some cases, the recipient already has the infection, such as hepatitis C. In other cases, the patient and physicians conclude that the risk of dying from the infection is less than the risk of dying while waiting for another organ.

“You balance the probability of infectious complications with the cost of not undergoing the transplant,” said Dorry Segev, a transplant surgeon and epidemiologist at Johns Hopkins University who had no involvement in the case. “The risk of death on dialysis is anywhere between 5 to 15 percent per year, and sometimes higher.”

Segev said that transplanting an organ from someone who died of an infection whose cause was not known would be “incredibly rare” but that it occasionally happens.

http://www.washingtonpost.com/national/health-science/maryland-rabies-case-came-from-kidney-transplant-sources-say/2013/03/14/4f47361e-8cf9-11e2-9f54-f3fdd70acad2_story.html

[Kong]

I just read this om my local papers site.

The Associated Press
Four people received donated organs from a man unknowingly infected with rabies, leading to a rare human death more than a year later that has authorities scrambling to treat the other three patients, federal health officials said Friday.
The man who died lived in Maryland and had received a kidney. The recipients of the donor's other kidney, heart and liver are getting anti-rabies shots, the federal Centers for Disease Control and Prevention said in a news release Friday. Those patients live in Florida, Georgia and Illinois.
The donor died in Florida in 2011 after moving there from North Carolina.
The CDC said it's working with public health officials and medical facilities in all five states to identify people who were in close contact with the donor or the four organ recipients. Those people might also need treatment, the agency said.
The Maryland patient's death more than a week ago prompted an investigation by state health officials that led to the announcement Tuesday of the state's first human death from rabies since 1976. Such deaths are rare, with typically just one to three cases diagnosed per year in the U.S., the CDC said.
The investigation revealed that the Maryland recipient had no reported animal exposures, the usual source of rabies transmission to humans. Investigators then confirmed that both the Maryland recipient and the Florida donor had died from the same type of raccoon rabies virus, the CDC said.
This type of type of rabies virus can infect not only raccoons, but also other wild and domestic animals. In the United States, only one other person is reported to have died from a raccoon-type rabies virus, the CDC said.
The organ transplants occurred more than a year before the Maryland recipient became ill and died, a period much longer than the typical rabies incubation period of one to three months. There have been other cases of such long incubation periods, however, the CDC said.
The donor died at a Florida medical facility. At the time of the donor's death, rabies wasn't suspected as the cause and testing for rabies was not performed, the CDC said. Rabies was only recently confirmed as the cause of death after the current investigation began in Maryland, the agency said.

http://www.palmbeachpost.com/ap/ap/environment/md-rabies-death-was-from-organ-transplant/nWsdJ/