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Volume 20, Number 9—September 2014
Synopsis

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

Table

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.
†http://www.cdc.gov/parasites/balamuthia/treatment.html.

Main Article

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Page created: August 13, 2014
Page updated: August 13, 2014
Page reviewed: August 13, 2014
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