Raccoon Rabies Virus Variant Transmission Through Solid Organ Transplantation

Abstract

Unlike the 2 previous clusters of rabies virus transmission through solid organ transplantation, there was a long incubation period in the recipient who developed rabies, and survival of 3 other recipients without pretransplant rabies vaccination. Rabies should be considered in patients with acute progressive encephalitis of unexplained etiology, especially for potential organ donors. A standard evaluation of potential donors who meet screening criteria for infectious encephalitis should be considered, and risks and benefits for recipients of organs from these donors should be evaluated.

Infection and Cancer Screening in Potential Living Donors: Best Practices to Protect the Donor and Recipient

“…Recent events in deceased organ donors (rabies, West Nile virus, balamuthia) considerably influenced the live organ donor workup and emphasized the importance of environmental exposure of the donor; however, given the very low prevalence of these infections and absence of widely available testing for some of these pathogens (e.g., balamuthia serology), universal donor screening would not be practical [22][23][24]29]. Furthermore, in the case of live donation, the time period between testing and donation should be taken into consideration as the transmissible disease may be contracted by a donor during this period.…”

“…While there have been no rabies virus transmissions through live-donor transplantation, the most recent case of raccoon rabies infection in the US was unusual as the transmission was not recognized until 18 months after the transplantation from a deceased donor who had not had a history of a recent exposure [24]. Thus, questions regarding animal bites or travel history may facilitate identification of past exposures [22].…”

Rabies: the clinical features, management and prevention of the classic zoonosis

“…There is a wide range of non-specifi c prodromal symptoms, so rabies patients have presented to rheumatologists, neurologists, psychiatrists, cardiologists, respiratory and acute medicine physicians, ear, nose and throat specialists, general and transplant surgeons 8 and GPs. The main clinical features 9,10 are listed in Box 1.…”

Rhabdovirus: Rabies

“…The donor, in retrospect, had displayed signs and symptoms consistent with rabies upon death: vomiting, upper extremity paresthesias, fever, seizures, dysphagia, autonomic dysfunction, and subsequent brain death. At the time of his death, his symptoms were thought to have been caused by ciguatera, a foodborne toxin [ 86 ]. The rabies viruses infecting the donor and deceased recipient of the kidney were found to be consistent with the raccoon rabies virus variant and were more than 99.9 % identical across the entire N gene (1,349/1,350 nucleotides), thus confi rming organ transplantation as the route of transmission [ 86 ].…”

“…At the time of his death, his symptoms were thought to have been caused by ciguatera, a foodborne toxin [ 86 ]. The rabies viruses infecting the donor and deceased recipient of the kidney were found to be consistent with the raccoon rabies virus variant and were more than 99.9 % identical across the entire N gene (1,349/1,350 nucleotides), thus confi rming organ transplantation as the route of transmission [ 86 ]. Three additional persons had received organs from the deceased donor: the other kidney, heart, and liver.…”