March 16, 2005 -- RabiesRabies occurs rarely among people, but it can spread through organ transplants from infected donors, says a new study.
Last year, four people died after receiving rabies-tainted organs or tissue from one donor, says the study. Doctors didn't know that the donor had rabies, probably from a bat bite. The organ donor had been healthy before having a stroke that led to his death.
"As organ and tissue transplantation becomes more common, the potential risks of disease transmission may increase," write the researchers. West Nile virus can also be spread through infected organs, they say. After a Transplant: What to Expect, How to CopeAfter a Transplant: What to Expect, How to Cope
Doctors should be aware of that and report any unusual outcomes in transplant recipients, says the study. Better national record keeping of such problems -- along with donors' autopsy reports, materials, and archived tissue samples -- could also help, write the researchers.
Few People Get Rabies
The four rabies cases unfolded in Texas in 2004. Rabies is extremely rare among people in the U.S. Only two cases were reported in 2003 and no more than six cases per year have been noted in the last decade, says the study.
However, the rabies virus is still present in some animals. Mainly wildlife -- bats, raccoons, foxes, skunks, and coyotes -- carry it in America. Pets are usually protected by rabies vaccines.
People can get rabies by being bitten by an infected animal. If there's any chance of rabies exposure, immediately clean the bite wound with soap and water and call a doctor. If rabies exposure is confirmed, a rabies vaccine can be given as a series of shots.
Had the Texas organ donor followed those steps last year, it might have saved lives.
As far as doctors knew at the time, he died of a brain hemorrhage. One person got his liver, two others each got a kidney, and a fourth got a blood vessel graft from the man after he died.
All four recipients showed signs of rabies within 30 days of their operation. They rapidly became sick, fell into a coma, and died with 50 days after their transplant.
That prompted a closer look at the man who had donated his organs. It turns out that he had twice gone to an emergency department four days before dying. He was nauseous, vomiting, and had trouble swallowing. He was also in an "altered" mental state, prompting his admission to another hospital, where he was found to have a high fever and blood pressure problems.
The man tested positive for cocaine and marijuana. A brain scan showed a hemorrhage that worsened, with seizures and a coma, before his death.
A Deadly Secret
After the man died, donor-screening tests didn't turn up any sign of infection. But rabies isn't part of those tests, and health care workers didn't know that the man had been bitten by a bat.
That key piece of information didn't surface until after the organ recipients had died. The man's friends told investigators that he'd told them about the bat bite. It's not known if the rabies infection caused the hemorrhage, says the study.
The report appears in the March 17 issue of The New England Journal of Medicine.