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.
Are you the 'Bat Lady' I saw on the Animal Channel the other night. She (the 'Bat Lady') lived in the Texas hill country and took in sick and injured bats and nursed them back to health.
I guess a transplanted cornea is considered tissue.
From my reading of the article, the organ donar died from the subarachnoid hemorrhage. Unless the imaging study, my guess it's a CAT scan, shows evidence of encephalitis, he had an occult rabies infection and was not yet symptomatic for rabies. I don't know about a lawsuit if they followed the standard of care. I'll re-read the article.
2. Is it possible for tetanus to be transmitted in blood transfusions and organ transplants? Are blood and organ donors screened for tetanus and if so, would the tetanus antibodies from long ago vaccines give a predictable yet false reading?
Thanks for being available to answer our questions.
Extremely unusual for the virus to spread through other than a bite.
The article stated, "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."
A common expression in medicine is "never say never in medicine".
2. Is it possible for tetanus to be transmitted in blood transfusions and organ transplants? Are blood and organ donors screened for tetanus and if so, would the tetanus antibodies from long ago vaccines give a predictable yet false reading?
Not that I'm aware of such modes of transmission. Anything may be possible, but from what I remember spores of Clostridium Tetani are dormant all over the place, but if you get a deep enough wound in which there are anaerobic conditions, then you could be SOL if you didn't get the "Td" booster immunization within the last ten years. IIRC, the spores change and start to produce a toxin. The hour is too late, and I'll take any help here. I never could type, and it's time to retire.
Incredible ! Patient dies of unknown ailment-organs viewed as OK for transplant.(Can you spell MALPRACTICE ? I THOUGHT you could !)
Interesting,informative...post,comments. Thanks.
Very strange, but interesting. I would say you will see a class-action lawsuit in the near future.
I think that most lay-people don't consider certain situations as potential to transmit rabies (although I think most would head to the doctor if bitten by a bat). Just today, we started rabies vaccine on a child who had a bat in his room. Since there is no way of knowing whether the child had come in contact with the bat, and also whether the bat carried rabies, the physicians erred on the side of caution and started the vaccine series. While the likelihood of rabies exposure is low in this situation, rabies is 100% fatal.
Just some advice to other freepers, especially those in rural settings: DON'T take in wild dogs or cats, especially if they are sickly, and if you do come in contact with the saliva of a wild animal, call your physician immediately (rabies virus is transmitted via the saliva, typically by a bite, but if the saliva comes in contact with broken skin or a mucous membrane even without a bite, it can be passed on that way also). The recommendations are that rabies post exposure vaccines be given within 72 hours of exposure, and that ideally it should be started as soon after exposure as possible.
It would appear that tetanus would be unlikely to be spread via transplant and blood transfusions.
That's what I was thinking. Crikey.
Actually, while a bite is the most common method of transmission, it can also be spread by contamination of scratches, abrasions, or mucous membranes with the saliva from a rabid animal.
I have never before heard that. Pets that are suspected of possible exposure are quarantined for 10 days. I have to go find some info on this. . .
I haven't had one in 8 years. Any idea if there is any immunity left in me?
News Break
07/08/2004 19:15:00 EST Fourth Transplant Patient Dies of Rabies
By SHEILA FLYNN
Associated Press Writer
DALLAS - A fourth patient died of rabies after receiving a transplant from an infected donor, health officials confirmed Thursday.
While the first three victims received organs from an Arkansas man who had the disease, the fourth victim received one of the man's arteries, officials at Baylor University Medical Center said.
The investigation of the deaths by the hospital and the Centers for Disease Control and Prevention traced the first three victims through organ donation records.
The fourth death was not confirmed until Thursday because the hospital had no tracking system tracing the artery donation.
"There's no master file or database that that information would subsequently be entered into," Baylor transplant surgeon Henry Randall said.
All four victims died within the same time frame in June.
Officials said the fourth victim was listed as the recipient of a liver from another donor, and was not immediately connected with the rabies case. Neurological problems leading to the patient's death, however, were similar to those of the other victims.
The lungs, kidneys and liver of the infected donor who died in May were donated to patients from Texas, Oklahoma and Alabama. Three of them died of rabies; the patient in Alabama died of complications in surgery.
The donor had shown no symptoms of rabies before his death from a brain hemorrhage, the CDC said.
William Sutker, chief of the department of infectious diseases at Baylor, said doctors did not initially diagnose rabies in any of the cases, instead suspecting encephalitis or meningitis.
"Rabies was not something that anybody could have, or would have, thought of," Sutker said.
The three deaths are the first documented cases of rabies being spread through organ transplants, the government said.
Officials were still conducting tests but said the chance of more infections was unlikely.
"All the tissue from this donor has been either used or destroyed," Sutker said.
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