Journal Article

Management and Outcomes after Multiple Corneal and Solid Organ Transplantations from a Donor Infected with Rabies Virus

T. Maier, A. Schwarting, D. Mauer, R. S. Ross, A. Martens, V. Kliem, J. Wahl, M. Panning, S. Baumgarte, T. Müller, S. Pfefferle, H. Ebel, J. Schmidt, K. Tenner-Racz, P. Racz, M. Schmid, M. Strüber, B. Wolters, D. Gotthardt, F. Bitz, L. Frisch, N. Pfeiffer, H. Fickenscher, P. Sauer, C. E. Rupprecht, M. Roggendorf, A. Haverich, P. Galle, J. Hoyer and C. Drosten

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 8, pages 1112-1119
Published in print April 2010 | ISSN: 1058-4838
Published online April 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/651267
Management and Outcomes after Multiple Corneal and Solid Organ Transplantations from a Donor Infected with Rabies Virus

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Background. This article describes multiple transmissions of rabies via transplanted solid organ from a single infected donor. The empirical Milwaukee treatment regimen was used in the recipients.

Methods. Symptomatic patients were treated by deep sedation (ketamine, midazolam, and phenobarbital), ribavirin, interferon, and active and passive vaccination. Viral loads and antibodies were continuously monitored.

Results. Recipients of both cornea and liver transplants developed no symptoms. The recipient of the liver transplant had been vaccinated ∼20 years before transplantation. Two recipients of kidney and lung transplants developed rabies and died within days of symptomatic disease. Another kidney recipient was treated 7 weeks before he died. The cerebrospinal fluid viral load remained at constant low levels (<10,000 copies/mL) for ∼5 weeks; it increased suddenly by almost 5 orders of magnitude thereafter. After death, no virus was found in peripheral compartments (nerve tissue, heart, liver, or the small intestine) in this patient, in contrast to in patients in the same cohort who died early.

Conclusions. Our report includes, to our knowledge, the longest documented treatment course of symptomatic rabies and the first time that the virus concentration was measured over time and in different body compartments. The postmortem virus concentration in the periphery was low, but there was no evidence of a reduction of virus in the brain.

Journal Article.  4039 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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