Posted on 07/01/2004 9:20:55 PM PDT by neverdem
In what federal officials said was the first case of its kind, three people who received organ transplants in May from a single donor in Texas died from rabies in June.
The donor was not suspected of having rabies at his death, which doctors attributed to a stroke, the Centers for Disease Control and Prevention said yesterday. It was not until this week, after a pathologist in Dallas who was puzzled about the deaths asked the federal agency for help, that the connection was made, Dr. Artun Srinivasan, a C.D.C. physician said in a telephone interview.
Dr. Mitchell L. Cohen, an expert on infectious diseases at the center, said in a telephone news conference that tests performed on Wednesday in Atlanta identified a strain of the rabies virus commonly found among bats in all four patients. It is not known when or where the donor was exposed to rabies. A year can pass from when a person is bitten by a rabid animal or exposed to a bat before rabies develops.
The bizarre case began about two months ago when the donor, a man, went to the Christus St. Michael Healthcare Center in Texarkana, Tex., complaining of confusion, Dr. Srinivasan said. He said that the man had a low fever and that a CAT scan showed bleeding in the brain consistent with a stroke known as a subarachnoid hemorrhage.
Dr. Cohen said that "rabies was not thought of as a likely cause" of the donor's death.
On May 4, the man's kidneys and liver were transplanted into patients at the Baylor University Medical Center in Dallas. His lungs were sent to Birmingham, where surgeons at the University of Alabama transplanted them. But the recipient died as a complication of the operation, not from rabies. The heart was not suitable for transplant.
From 21 to 27 days after receiving their organs, the three survivors, who had gone home, began to develop encephalitis. They became confused, lethargic, lost their appetite and developed seizures, muscle jerking and other problems. A woman who received a kidney had an appendectomy for severe abdominal pain, but became increasingly lethargic after the operation.
The liver recipient, a man, received critical care support before he died on June 7, and the kidney recipients on June 8 and 21.
On June 9, Dr. Elizabeth C. Burton, a pathologist at Baylor, called the disease control center for help in solving the puzzle of why the first two recipients had died. But, Dr. Srinivasan said, "no one suspected rabies until this week, when the diagnosis was made at C.D.C."
Dr. Burton and Baylor University Hospital did not respond to requests for comment.
There is no effective therapy for rabies, which is usually fatal. But injections of two types of immunizations can prevent rabies if they are given soon after exposure. So health officials at the disease control centers and in four states, Alabama, Arkansas, Oklahoma and Texas, are seeking to identify quickly anyone who had contact with the four patients to determine who needs immunizations. People exposed to patients' saliva are those most likely to need treatment.
Officials said the risk of rabies transmission from patients to hospital and other workers was very low.
Nevertheless, "it's very scary for all the health care workers" and family members, Dr. Cohen said. "This has never happened before, and we want to prevent it from happening again."
Although rabies has never been transmitted from an organ donor, eight people - one in the United States and seven elsewhere - have developed rabies after having corneal transplants.
There have only been two reports, both in Ethiopia, of rabies being transmitted among members of the same household. Neither case was confirmed by laboratory testing.
Federal officials are expected to review the findings to determine whether to add rabies to the routine tests for all organ donors. Donors are now tested for H.I.V., hepatitis B and C, HTLV-1, cytomegalovirus and syphilis.
Some organ procurement agencies ask about rabies exposure, said Virginia McBride, a specialist on organ donation at the Health Resources and Services Administration.
Officials said the case should not deter people from donating or receiving organs because the benefits so far outweighed the risks.
WOW! PING
I heard about this on the radio. Not good at all...
"...donor, a man, [was] complaining of confusion..."
Seems to me like we are completely lost: this symptom applies both to me and to everyone I know...
Here in Dallas, on WFAA, the doctors said the donor was likely bitten by a bat, but didn't tell anybody.
"Parts is parts" (if you're lucky).
Boy, talk about sadly unlucky! I wonder what the odds would be -- An MD and not reporting.
I did not know this.
What are the testing standards set forth by the American Association of Tissue Banks relating to rabies? Any blood test at this stage should make it evident the tissue is useless, right?
Yes this if very true. But usually it shows up within 2 months. I take rabies shots (and have for 16 years) and the 1st time I was bitten by a rabid bat I got lots of info about rabies pretty quickly. Usually you have a month to get the shots and a month to build imunity if not.... you are dead. That is just how it is. I tell the kids ... don't touch bats because rabies is quicker and deadlier than AIDS.
The info about transmission via saliva, does that apply to any ambulance chasers starting to drool after reading about the 3 plantiff, er, uh, victim's families?
As a liver transplant recipient(1-6-02) ,this is very sad.This is not the way it's supposed to work.
It's even deadlier than Ebola.
I don't do transplants and don't have a clue.
The article states, "Federal officials are expected to review the findings to determine whether to add rabies to the routine tests for all organ donors. Donors are now tested for H.I.V., hepatitis B and C, HTLV-1, cytomegalovirus and syphilis."
HTLV-1 is HIV.
This is how the world works. Civilian airplanes were not supposed to be guided missiles. Good luck with your meds.
"An MD not and reporting."
I don't follow.
Had me pretty rattled, too, when I read it. I'm a double lung recipient (7/11/02). You know there are risks, but this is one I never would have considered.
HTLV-1 is HIV NOT.
I looked for HIV at first in that sentence and didn't see it.
IIRC, HTLV-3 is what we now call HIV.
That is funny that a "serious" tone on saliva is made on rabies. I was learned that rabies virus is just as adaptable as HIV. HIV saliva transmission is poo-pooed as trivial in most conversations...unless you receive it.
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