Volume 20, Number 9—September 2014
Encephalitis Caused by Pathogens Transmitted through Organ Transplants, 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.
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