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Volume 20, Number 9—September 2014

Encephalitis Caused by Pathogens Transmitted through Organ Transplants, United States, 2002–2013

Sridhar V. BasavarajuComments to Author , Matthew J. Kuehnert, Sherif Zaki, and James Sejvar
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article


Infectious agents associated with encephalitis reported among clusters of solid organ transplant recipients in the United States, 2002–2013*

Infectious agent Classification Natural transmission route No. reported clusters Clinical features of infection Laboratory detection method Treatment
WNV Enveloped, positive, single-stranded RNA virus; Flavivirus family Bites from infected mosquitoes (Culex spp.) 6 Febrile illness, meningitis, encephalitis, poliomyelitis-like limb paralysis Detection of WNV-specific antibodies or WNV nucleic acid in serum or CSF samples None; several experimental therapies under investigation
Rabies virus Enveloped, negative, single-stranded RNA virus; Rhabdoviridae family, Lyssavirus genus Exposure to secretions, typically saliva, of infected animals (in North America, most commonly bats, raccoons, and skunks) 2 Nonspecific prodrome followed by confusion, paresthesias, insomnia, agitation, paresis, spasm of swallowing muscles, coma, and death Before death:
 PCR or virus isolation in saliva, PCR and fluorescent antibody testing of nuchal biopsy samples, antibody testing of serum, and PCR or antibody testing of CSF;
after death:
fluorescent antibody staining of brain tissue or frozen tissue from nuchal biopsy, and serologic diagnosis by neutralization tests in mice or cell culture Supportive; treatment with induced coma and antiviral therapy, as reported (36); 
postexposure prophylaxis for asymptomatic recipients of organs from infected donors
LCMV Enveloped, RNA virus; Arenaviridae family Exposure to infected rodents, presumably to urine 3 Febrile illness in most symptomatic persons; aseptic meningitis, encephalitis Cell culture, electron microscopy, immunohistochemistry, detection of LCMV antibodies, PCR or high-throughput sequencing Supportive
Balamuthia mandrillaris Free-living aerobic amebae Ubiquitous in soil 2 Skin lesions; single or multiple space-occupying intracranial lesions; granulomatous amebic encephalitis characterized by hemiparesis, aphasia, seizures Culture or identification of amebic trophozoites or cysts in biopsy sample of affected tissue; real-time PCR of CSF Multidrug combinations, which may include pentamidine isethionate, 5-flucytosine,
fluconazole, clarithromycin or azithromycin, sulfadiazine,
miltefosine, thioridazine, or liposomal amphotericin B†

*CSF, cerebrospinal fluid; LCMV, lymphocytic choriomeningitis virus; WNV, West Nile virus.

Main Article

  1. United Network for Organ Sharing. Organ Procurement and Transplantation Network. 2012 [cited 2013 Jan 3].
  2. Balakrishnan  SL, Armstrong  D, Rubin  AL, Stenzel  KH. Cytomegalovirus infection after renal transplantation. Report of a case with viremia and atypical lymphocytosis. JAMA. 1969;207:17124 . DOIPubMed
  3. Hiesse  C, Charpentier  B, Fries  D, Simonneau  G, Delfraissy  JF. Human immunodeficiency virus infection in transplant recipients. Ann Intern Med. 1986;105:301 . DOIPubMed
  4. Morris  MI, Fischer  SA, Ison  MG. Infections transmitted by transplantation. Infect Dis Clin North Am. 2010;24:497514. DOIPubMed
  5. Ellingson  K, Seem  D, Nowicki  M, Strong  DM, Kuehnert  MJ. Organ Procurement Organization Nucleic Acid Testing Yield Project T. Estimated risk of human immunodeficiency virus and hepatitis C virus infection among potential organ donors from 17 organ procurement organizations in the United States. Am J Transplant. 2011;11:12018. DOIPubMed
  6. Long  SS. Encephalitis diagnosis and management in the real world. Adv Exp Med Biol. 2011;697:15373 . DOIPubMed
  7. Pealer  LN, Marfin  AA, Petersen  LR, Lanciotti  RS, Page  PL, Stramer  SL, Transmission of West Nile virus through blood transfusion in the United States in 2002. N Engl J Med. 2003;349:123645. DOIPubMed
  8. Iwamoto  M, Jernigan  DB, Guasch  A, Trepka  MJ, Blackmore  CG, Hellinger  WC, Transmission of West Nile virus from an organ donor to four transplant recipients. N Engl J Med. 2003;348:2196203. DOIPubMed
  9. Srinivasan  A, Burton  EC, Kuehnert  MJ, Rupprecht  C, Sutker  WL, Ksiazek  TG, Transmission of rabies virus from an organ donor to four transplant recipients. N Engl J Med. 2005;352:110311 . DOIPubMed
  10. Centers for Disease Control and Prevention. Lymphocytic choriomeningitis virus infection in organ transplant recipients—Massachusetts, Rhode Island, 2005. MMWR Morb Mortal Wkly Rep. 2005;54:5379 .PubMed
  11. Centers for Disease Control and Prevention. Balamuthia mandrillaris transmitted through organ transplantation—Mississippi, 2009. MMWR Morb Mortal Wkly Rep. 2010;59:116570 .PubMed
  12. Hayes  EB, Komar  N, Nasci  RS, Montgomery  SP, O'Leary  DR, Campbell  GL. Epidemiology and transmission dynamics of West Nile virus disease. Emerg Infect Dis. 2005;11:116773 . DOIPubMed
  13. Centers for Disease Control and Prevention. West Nile virus disease and other arboviral diseases—United States, 2011. MMWR Morb Mortal Wkly Rep. 2012;61:5104 .PubMed
  14. Centers for Disease Control and Prevention. West Nile virus transmission through blood transfusion—South Dakota, 2006. MMWR Morb Mortal Wkly Rep. 2007;56:769 .PubMed
  15. Centers for Disease Control and Prevention. West Nile virus transmission via organ transplantation and blood transfusion—Louisiana, 2008. MMWR Morb Mortal Wkly Rep. 2009;58:12637 .PubMed
  16. Meny  GM, Santos-Zabala  L, Szallasi  A, Stramer  SL. West Nile virus infection transmitted by granulocyte transfusion. Blood. 2011;117:57789. DOIPubMed
  17. Nett  RJ, Kuehnert  MJ, Ison  MG, Orlowski  JP, Fischer  M, Staples  JE. Current practices and evaluation of screening solid organ donors for West Nile virus. Transpl Infect Dis. 2012;14:26877 . DOIPubMed
  18. Centers for Disease Control and Prevention. West Nile virus infections in organ transplant recipients—New York and Pennsylvania, August–September, 2005. MMWR Morb Mortal Wkly Rep. 2005;54:10213 .PubMed
  19. Busch  MP, Kleinman  SH, Tobler  LH, Kamel  HT, Norris  PJ, Walsh  I, Virus and antibody dynamics in acute West Nile virus infection. J Infect Dis. 2008;198:98493. DOIPubMed
  20. Murray  K, Walker  C, Herrington  E, Lewis  JA, McCormick  J, Beasley  DW, Persistent infection with West Nile virus years after initial infection. J Infect Dis. 2010;201:24. DOIPubMed
  21. Dietzschold  B, Schnell  M, Koprowski  H. Pathogenesis of rabies. Curr Top Microbiol Immunol. 2005;292:4556 and. DOIPubMed
  22. Jackson  AC, Warrell  MJ, Rupprecht  CE, Ertl  HC, Dietzschold  B, O'Reilly  M, Management of rabies in humans. Clin Infect Dis. 2003;36:603. DOIPubMed
  23. Gode  GR, Bhide  NK. Two rabies deaths after corneal grafts from one donor. Lancet. 1988;2:791. DOIPubMed
  24. Maier  T, Schwarting  A, Mauer  D, Ross  RS, Martens  A, Kliem  V, Management and outcomes after multiple corneal and solid organ transplantations from a donor infected with rabies virus. Clin Infect Dis. 2010;50:11129. DOIPubMed
  25. Vora  NM, Basavaraju  SV, Feldman  KA, Paddock  CD, Orciari  L, Gitterman  S, Raccoon rabies virus variant transmission through solid organ transplantation. JAMA. 2013;310:398407. DOIPubMed
  26. Rousseau  MC, Saron  MF, Brouqui  P, Bourgeade  A. Lymphocytic choriomeningitis virus in southern France: four case reports and a review of the literature. Eur J Epidemiol. 1997;13:81723. DOIPubMed
  27. Biggar  RJ, Woodall  JP, Walter  PD, Haughie  GE. Lymphocytic choriomeningitis outbreak associated with pet hamsters. Fifty-seven cases from New York State. JAMA. 1975;232:494500. DOIPubMed
  28. Al-Zein  N, Boyce  TG, Correa  AG, Rodriguez  V. Meningitis caused by lymphocytic choriomeningitis virus in a patient with leukemia. J Pediatr Hematol Oncol. 2008;30:7814. DOIPubMed
  29. Fischer  SA, Graham  MB, Kuehnert  MJ, Kotton  CN, Srinivasan  A, Marty  FM, Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med. 2006;354:223549. DOIPubMed
  30. Barton  LL. LCMV transmission by organ transplantation. N Engl J Med. 2006;355:1737. DOIPubMed
  31. Centers for Disease Control and Prevention. Brief report: lymphocytic choriomeningitis virus transmitted through solid organ transplantation—Massachusetts, 2008. MMWR Morb Mortal Wkly Rep. 2008;57:799801 .PubMed
  32. Palacios  G, Druce  J, Du  L, Tran  T, Birch  C, Briese  T, A new arenavirus in a cluster of fatal transplant-associated diseases. N Engl J Med. 2008;358:9918. DOIPubMed
  33. Martínez  AJ, Visvesvara  GS. Balamuthia mandrillaris infection. J Med Microbiol. 2001;50:2057 .PubMed
  34. Bravo  FG, Alvarez  PJ, Gotuzzo  E. Balamuthia mandrillaris infection of the skin and central nervous system: an emerging disease of concern to many specialties in medicine. Curr Opin Infect Dis. 2011;24:1127. DOIPubMed
  35. Centers for Disease Control and Prevention. Notes from the field: transplant-transmitted Balamuthia mandrillaris—Arizona, 2010. MMWR Morb Mortal Wkly Rep. 2010;59:1182 .PubMed
  36. Willoughby  RE Jr, Tieves  KS, Hoffman  GM, Ghanayem  NS, Amlie-Lefond  CM, Schwabe  MJ, Survival after treatment of rabies with induction of coma. N Engl J Med. 2005;352:250814. DOIPubMed
  37. Cramer  CH II, Shieck  V, Thomas  SE, Kershaw  DB, Magee  JC, Lopez  MJ. Immune response to rabies vaccination in pediatric transplant patients. Pediatr Transplant. 2008;12:8747. DOIPubMed
  38. Rhee  C, Eaton  EF, Concepcion  W, Blackburn  BG. West Nile virus encephalitis acquired via liver transplantation and clinical response to intravenous immunoglobulin: case report and review of the literature. Transpl Infect Dis. 2011;13:3127. DOIPubMed
  39. Domen  RE, Nelson  KA. Results of a survey of infectious disease testing practices by organ procurement organizations in the United States. Transplantation. 1997;63:17904. DOIPubMed
  40. Kleinman  SH, Glynn  SA, Higgins  MJ, Triulzi  DJ, Smith  JW, Nass  CC, The RADAR repository: a resource for studies of infectious agents and their transmissibility by transfusion. Transfusion. 2005;45:107383. DOIPubMed

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Page created: August 13, 2014
Page updated: August 13, 2014
Page reviewed: August 13, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.