Transmission of West Nile Virus from an Organ Donor to Four Transplant Recipients

Iwamoto, Martha; Jernigan, Daniel B.; Guasch, Antonio; Trepka, Mary Jo; Blackmore, Carina; Hellinger, Walter C.; Pham, Si M.; Zaki, Sherif R.; Lanciotti, Robert S.; Lance-Parker, Susan; DiazGranados, Carlos A.; Winquist, Andrea; Perlino, Carl A.; Wiersma, Steven; Hillyer, Krista L.; Goodman, Jesse L.; Marfin, Anthony A.; Chamberland, Mary E.; Petersen, Lyle R.

doi:10.1056/nejmoa022987

Cited by 629 publications

(374 citation statements)

References 14 publications

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“…In addition, cases of WNV infection in solid organ transplantation have also been recently reported. 25 The WN virus-associated clinical syndromes are nonspecific and a diagnosis cannot reliably be made on clinical grounds alone. However, the incidence of encephalitis increases with age.…”

Section: West Nile Virus Encephalitis In Bmt P Reddy Et Almentioning

confidence: 99%

West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation

Reddy¹,

Davenport

Ratanatharathorn³

et al. 2003

Bone Marrow Transplant

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Summary:We describe here a patient who died of progressive CNS deterioration following allogeneic stem cell transplant with West Nile virus as the sole pathogen on the cerebrospinal fluid and brain tissue analysis. A 50-yearold male with Philadelphia chromosome-positive acute lymphocytic leukemia (ALL) underwent allogeneic PBSCT from his HLA identical sister. After engraftment, the patient developed fever with progressive and ultimately fatal neurological deterioration. Imaging studies of the brain including CT and MRI scans were remarkable for mild low attenuation lesions of the white matter. CSF analysis was negative for neoplastic cells, bacteria, AFB, CMV, HSV, fungal infections and leukemic relapse. However, serological analysis of both the serum and CSF was positive for West Nile virus-specific IgM antibodies. At autopsy, West Nile virus PCR and cultures were positive in the mid-brain tissue. Electron micrographs showed evidence of viral particles. Given the recent increase in the spread of West Nile virus infections and the increased susceptibility of BMT patients to infectious complications, West Nile virus encephalitis should be considered in patients undergoing transplantation.

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Section: West Nile Virus Encephalitis In Bmt P Reddy Et Almentioning

confidence: 99%

West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation

Reddy¹,

Davenport

Ratanatharathorn³

et al. 2003

Bone Marrow Transplant

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“…The first outbreak of West Nile virus in the United States in 1999 led to the geographic expansion of this vector-borne virus. West Nile virus is usually a mosquito-borne infection, although transmission through blood or transplanted organs has been reported (2). In healthy individuals, symptoms typically include 3-6 days of malaise, anorexia, arthralgia, vomiting, nausea, rash, and lymphadenopathy.…”

Section: Introductionmentioning

confidence: 99%

West Nile Virus-Associated Meningoencephalitis in Two Chronically Immunosuppressed Renal Transplant Recipients

Hardinger

Miller²,

Storch

et al. 2003

American Journal of Transplantation

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“…Less common but important viruses can be transmitted via liver transplant, including West Nile Virus (WNV). [145][146][147] Recognizing emerging infectious diseases in liver transplantation is challenging because of nonstandardization of donor evaluations and data collection as well as surveillance of the recipient. Quantifying risk is further complicated by the absence of data regarding the factors affecting disease transmission.…”

Section: Issues On Transmissionmentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

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Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

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Transmission of West Nile Virus from an Organ Donor to Four Transplant Recipients

Cited by 629 publications

References 14 publications

West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation

West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation

West Nile Virus-Associated Meningoencephalitis in Two Chronically Immunosuppressed Renal Transplant Recipients

Infections After Orthotopic Liver Transplantation

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