This findings suggests that rabies transmitted by this route may have a longer incubation period, and that although solid organ transplant transmission of infectious encephalitis is rare, further education to increase awareness is needed.
The rabies virus causes a fatal encephalitis (inflammation of the brain) and can be transmitted through tissue or organ transplantation.
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]).
The 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 post-exposure 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 .
(culled from materials from American medical association.)
