Rabies transmission through solid organ transplantation

Burton EC, Burns, DK, Opatowsky MJ, El-Fekt WH, et al. Raies encephalomyelitis. Clinical, neuroradiological, and pathologic findings in 4 transplant recipients. Arch Neurol. 2005; 62: 873-882.

Rabies has been transmitted through animal bites, most commonly bats, also through corneal transplants. 4 individuals received organs from a single donor with unsuspected rabies who had suspected cocaine induced agitation. All recipients were readmitted within a month of receiving their organs with symptoms that rapidly progressed to coma and death. Theyincluded sleep deprivation, tremors, decreased appetite, abdominal and back pain, itching (one underwent appendectomy for abdom pain), delirium, myoclonus, and eventually death.

LP done on 3 patients, all had normal glucose, 2 had high protein (69,229), all had increased cells (7-32), all had negative viral cultures.

MRI's were bilaterally abnormal in PVWM, leptomeninges, medial temporal lobes, inferior frontal lobes, subinsular cortex, precentral gyus, basal ganglia, thalami, midbrain, hippocampi , cerebral peduncles and cerebellum. Initial CT's were all normal.

EEG's showed moderate to severe slowing, one patient ultimately had seizures. Diagnosis was made at post mortem.

The cardinal signs of classic rabies encephalitic form are fluctuating consciousness, phobic spasms, and autonomic dysfunction. Bat rabies patients canhave local pain at bite site (burbing, numbness, itching, but might be unknown). Symptoms reported include anisocoria, bilateral ptosis, diplopia, nystagmus, pinpoint pupils, intermittent facial palsy, tremor, and rarely seizures (especially in bat rabies). Also, patients may experience hemiparesis, hemisensory loss, assymmetric reflexes or cranial neuropathies.