3 Fatal Cases of Rabies Are Linked to Ill Donor

NY Times ^ | July 2, 2004 | LAWRENCE K. ALTMAN

[blam]

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.

[neverdem]

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.

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.

[bd476]

1. A local vet was exposed to rabies when a rabid cat bit her during a routine examination. The cat had been transported as a pet across the Mexican border sans quarantine. Perhaps the man was similarly bitten and assumed that it was a "normal" cat (or dog, raccoon or oppossum) bite?

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?

[JudyB1938]

Thanks for being available to answer our questions.

[goldstategop]

Extremely unusual for the virus to spread through other than a bite.

[neverdem]

1. A local vet was exposed to rabies when a rabid cat bit her during a routine examination. The cat had been transported as a pet across the Mexican border sans quarantine. Perhaps the man was similarly bitten and assumed that it was a "normal" cat (or dog, raccoon or oppossum) 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.

[genefromjersey]

Incredible ! Patient dies of unknown ailment-organs viewed as OK for transplant.(Can you spell MALPRACTICE ? I THOUGHT you could !)

[PGalt]

Interesting,informative...post,comments. Thanks.

[mean lunch lady]

Very strange, but interesting. I would say you will see a class-action lawsuit in the near future.

[Born Conservative]

WOW is right! Who would have ever thought this could happen? I'm sure that rabies isn't at the top of the differential diagnosis list when dealing with post-transplant problems.

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.

[Born Conservative]

Per the 2003 Red Book: "This organism is a wound contaminant that causes neither tissue destruction nor an inflammatory response. The vegetative form of C. tetani produces a potent plasmid-encoded exotoxin (tetanospasmin), which binds to gangliosides at the myoneural junction of skeletal muscle and on neuronal membranes in the spinal cord, blocking inhibitory pulses to motor neurons." and "Wounds, recognized and unrecognized, are the sites at which the organism multiplies and elaborates toxin. Contaminated wounds, especially those with devitalized tissue and deep-puncture trauma, are at greatest risk".

It would appear that tetanus would be unlikely to be spread via transplant and blood transfusions.

[mewzilla]

That's what I was thinking. Crikey.

[Born Conservative]

Extremely unusual for the virus to spread through other than a bite.

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.

[Flyer]

A year can pass

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. . .

[Flyer]

I take rabies shots

I haven't had one in 8 years. Any idea if there is any immunity left in me?

[Sunshine55]

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.