Man died of rabies from kidney transplant

Posted on: 1:44 pm, March 15, 2013, by , updated on: 01:28pm, March 15, 2013

By Elizabeth Cohen and John Bonifield, CNN

(CNN) — A Maryland man recently died of rabies that he contracted from a tainted kidney he received in a transplant operation a year and a half ago, the Centers for Disease Control and Prevention said Friday.

Health care teams are now giving anti-rabies shots to three other patients who received organs from the same donor as the patient, the CDC said.

The Maryland man and three other people — in Florida, Georgia and Illinois — received organs from a person who died in Florida in 2011.

Doctors knew the donor had encephalitis, an inflammation of the brain, when they harvested the organs. However, they didn’t know rabies was the cause.

At the time, rabies wasn’t suspected as the cause of the donor’s death, and no rabies test was done before the donor’s kidneys, heart and liver were delivered for transplantation in September 2011, the CDC said.

The Maryland recipient died February 27 at a VA Medical Center in Washington after falling ill. Health officials investigating his death made the rabies diagnosis this month. Officials then re-examined the donor’s death and determined the donor also died of rabies, according to the CDC.

The agency is looking for family members or health care workers who might have had close contact with the donor or the recipients to see if they have rabies, according to CDC spokeswoman Melissa Dankel.

It marks the second time organ transplant recipients have fallen ill with rabies in the United States. In 2004, four people died when tainted organs and tissue were taken from a rabies-infected donor. No one knew the donor had rabies until after the recipients became ill.

In this most recent case, the donor was experiencing “changes in mental status” before he died, according to Dr. Matthew Kuehnert, director of the CDC’s Office of Blood, Organ, and Other Tissue Safety. He said doctors in Florida tested the donor for various causes of encephalitis, including West Nile Virus and herpes, but did not test for rabies.

Organ donors are not routinely tested for rabies, even if they show the signs. One reason is rabies is extremely rare, with only one to three cases a year nationwide, according to Dr. Richard Franka, the CDC’s acting rabies team lead.

Also, many lifesaving organs would be lost if the donors were tested for rabies. Only three or four facilities in the country are capable of testing for rabies in humans, Franka said, which means most hospitals would have to ship a potential donor’s blood or tissue. It could take two days to get test results, and by then the organs would no longer be usable.

Hospitals do test for other causes of encephalitis, and if no cause is found, the organs are donated.

Perhaps this needs to be changed, Kuehnert said.

“What we need looking forward is a standardized approach when you have encephalitis of unknown cause so very important things like this aren’t missed,” he said.

Because rabies was suspected, portions of the patient’s brain were sent to the CDC, which did testing and confirmed rabies. At the request of the CDC, the Florida hospital sent part of the donor’s brain, which had been saved. The CDC quickly determined that both donor and recipient died from the raccoon-type rabies virus.

The other three recipients were immediately contacted. They show no signs of rabies but are being treated with five doses of the rabies vaccine and rabies immune globulin, which gives the body antibodies to protect itself against the rabies virus. Both treatments are shots in the upper arm.

Kuehnert said the recipients’ doctors were shocked to learn the donor’s organs were tainted with rabies.

“Their first reaction was that it seemed unlikely because it’s been almost a year and a half since the transplant,” he said.

In 2004, the recipients of the tainted organs died within a month of the transplant.

“This kind of incubation period — 17 months — is quite unusual,” he said.

CNN’s Miriam Falco and Georgiann Caruso contributed to this report.

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