AR-News: (OK - US) Three die of rabies infection from organ transplants

[Snugglezzz at aol.com]

Three die of rabies infection 
By STAFF AND WIRE REPORTS 
7/2/2004 


An Oklahoman and two other people had received organs transplants from a man 
infected with rabies. 

Three people have died of rabies -- one of them an Oklahoman -- after 
receiving infected organs from the same donor in what the government says are the 
first documented cases of the disease being spread through organ transplants. 



Federal agencies are now looking into whether transplant organs should be 
screened for the rabies virus. 

The lungs, kidneys and liver of an Arkansas man who died in May were donated 
to four patients in Texas, Oklahoma and Alabama, the Centers for Disease 
Control and Prevention in Atlanta said Thursday. Three of them died of rabies; the 
fourth, in Alabama, died of complications during surgery, the CDC said. 

A man from central Oklahoma who received a liver transplant at Baylor 
University Medical Center in Dallas was one of the people who died, said Kristy 
Bradley of the Oklahoma  

State Department of Health. 

The liver was transplanted May 4, and the patient was discharged from the 
hospital five days later, Bradley said. Three weeks later, he began having 
symptoms, including loss of appetite, fatigue, muscle tremors, hypersensitivity of 
the skin and mental confusion. His wife took him back to the hospital, where he 
became comatose and was intubated, Bradley said. 

An MRI showed that the organ donor's brain was bleeding, but doctors didn't 
consider that rabies could be to blame, Bradley said. 

An investigation started when all the transplant recipients died from similar 
problems, Bradley said. 

Although no case has been documented of one person spreading rabies to 
another through casual contact, the Health Department is assessing those who were in 
contact with the Oklahoma man who received the liver. The rabies virus is 
found in saliva, so those who kissed the man or shared eating utensils with him 
might need to receive post-exposure immunizations, Bradley said. 

While these are the first known cases of rabies being spread through donated 
organs, at least eight people have contracted the virus through cornea 
transplants, the CDC said. 

Rabies testing is not routinely done on U.S. organ do nors, although there 
are routine screenings for other diseases, including hepatitis B and C, HIV and 
syphilis. Rabies has not been found in donated blood. 

The blood supply is safe because the rabies virus is not found in blood, 
Bradley said. 

LifeShare Donor Transplant Services of Oklahoma asks families of potential 
organ donors two questions about rabies, said Phil Van Stavern of LifeShare. 

First, they are asked if in the last 12 months their loved one was bitten by 
an animal suspected of having rabies. 

Second, they are asked if the person had been vaccinated for rabies, and if 
so, why and when, Van Stavern said. 

Rabies is not present in the blood, but is present and spreads only through 
the nervous system. Therefore, brain tissue must be tested, Bradley said. The 
fluorescent antibody test takes at least four to six hours, Bradley said. 

The other tests that LifeShare performs -- for hepatitis B, hepatitis C, a 
herpes virus called CMV, two precursors to cancer and West Nile virus -- all can 
be performed quickly, Van Stavern said. 

The CDC said it is working with health officials in the four states to 
determine whether other people who had contact with the organ recipients or the 
donor need treatment for rabies. 

Rabies cases in humans are extremely rare in the United States. On average, 
only one or two people die from the disease each year, according to the CDC. 
There were no human cases in 2001, the latest year for which figures are 
available. The last person in Oklahoma to die of rabies was a 27-year-old man who 
died from a skunk strain of the virus in 1981. 

The most recent death was caused by a bat strain of the virus, which is much 
more common, Bradley said. Bats' teeth are so small that most people don't 
recognize the spot as a bite and don't go to the doctor, Bradley said. 

Because of the danger, public health officials encourage parents to teach 
children not to pick up bats because any bat that can be picked up is sick or 
injured, she said. 

If people find a bat flying in the home, they should wear gloves to collect 
it. They should be careful not to hit it forcefully because if the brain tissue 
is damaged, it cannot be tested for rabies, Bradley said. 

In the transplant-patient deaths, the virus could have been in the nerves of 
the transplanted organs, said Dr. Mitchell Cohen, director of the CDC 
coordinating center for infectious diseases. 

Symptoms of rabies can include fever or headache, and later, confusion, 
sleepiness or agitation. People usually start to show signs up to three months 
after being infected. 

Last fall, scientists discovered the West Nile virus could spread through 
blood transfusions and organ transplants. That led to the screening of blood 
donations for the mosquito-borne virus. 



 
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