Arenaviruses and West Nile Virus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Abstract

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the epidemiology, diagnosis, prevention, and management of infection due to Arenaviruses and West Nile Virus (WNV) in the pre‐ and post‐transplant period. Arenaviruses and WNV have been identified as causes of both donor‐derived and post‐transplant infection. Most data related to these infections have been published in case reports and case series. Transplant recipients may become infected with Arenaviruses if they, or their donors, are exposed to wild rodents or infected pet rodents. Lymphocytic choriomeningitis virus is the most commonly recognized Arenavirus among transplant recipients and should be considered when transplant recipients present with fever, hepatitis, meningitis/encephalitis, and/or multisystem organ failure. WNV is a mosquito‐borne virus, and as such, its incidence varies yearly depending on environmental conditions. WNV in transplant recipients typically presents with fever, myalgias, and rash; approximately one in 40 develop neuroinvasive disease. Due to its morbidity, the Organ Procurement and Transplantation Network recently mandated that transplant centers screen living donors for WNV infection in endemic areas. Little is known about the optimal treatment of Arenaviruses or WNV; reduction in immunosuppression and supportive care are the mainstays of management at present.

Comparative Pathology of West Nile Virus in Humans and Non-Human Animals

“…Overwintering of WNV may also occur by vertical transmission from adult female mosquitoes to their progeny, although this process is highly inefficient [44,45]. In addition to the maintenance of WNV in nature via non-vector mechanisms, WNV disease has also been reported in humans potentially as a result of non-vector transmission including percutaneous exposure, transplacental transmission, breast milk consumption, blood transfusion and organ transplant [46][47][48][49][50][51].…”

Coronavirus disease 2019: Implications of emerging infections for transplantation

“…When West Nile virus emerged in the United States in 1999, we quickly learned that transplant recipients were at particular risk for significant morbidity and mortality from blood transfusions and organs obtained from donors with either asymptomatic infection or (for donors) encephalitis of unclear etiology 17. Concerns of Zika virus having similar impact have thus far not been borne out despite a viremic phase and reminds us that being cautious in an uncertain situation must be balanced with the alternative risk of not transplanting.…”

West Nile Virus: An Emerging Threat in Transplant Population

“…In an attempt to improve transplant outcomes related to WNV disease, identification of infected organ and blood donors is necessary in WNV endemic areas during increased WNV activity (Winston et al 2014, Anesi et al 2019. Although current recommendations and screening practices of organ donors for WNV are not harmonized, WNV nucleic acid amplification testing is recommended (Anesi et al 2019). Deferral of organ donors with known WNV infection or recent fever or unexplained neurologic symptoms should be considered (Winston et al 2014, Anesi et al 2019.…”

“…Although current recommendations and screening practices of organ donors for WNV are not harmonized, WNV nucleic acid amplification testing is recommended (Anesi et al 2019). Deferral of organ donors with known WNV infection or recent fever or unexplained neurologic symptoms should be considered (Winston et al 2014, Anesi et al 2019.…”

“…In the post-transplant period, WNV infection may be prevented by avoiding mosquito bites. Patients should be counseled to avoid outdoor activities in the period of the highest mosquito activity, to use long sleeves and long pants, and to apply repellents on exposed skin (Anesi et al 2019).…”