1189. Fatal transplant-associated West Nile virus encephalitis and public health response California, 2010
Session: Poster Abstract Session: Non-CMV Viruses and Transplantation
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

West Nile virus (WNV) infection acquired through solid organ transplantation can result in severe disease.  Of the 10 cases reported to public health agencies in the United States, 7 patients had encephalitis and 3 died.  In 2010, the California Encephalitis Project identified a case of WNV encephalitis that occurred shortly after organ transplantation in a kidney recipient. We report the findings of the investigation.

Methods: 

We reviewed recent local WNV activity (human and ecologic), medical records, and transfusion history for the deceased organ donor and three organ recipients.  Patients’ blood and cerebrospinal fluid (CSF) were tested for WNV infection by serology and nucleic acid amplification test (NAT), and tissues by NAT and immunohistochemical staining.

Results: 

Kidney recipient A, a 73 year-old male, developed encephalitis on post-transplant day (PTD) 8 and died 13 weeks later. WNV infection was confirmed by WNV IgM and neutralizing antibodies in serum and CSF collected between 17-49 days after illness onset, and later by NAT on post-mortem brain tissue. He received one unit of packed red blood cells (PRBC) prior to illness onset.  The donor of the PRBCs, which had screened negative for WNV RNA by minipool-NAT, had no detectable WNV IgM antibodies 113 days after donation. The organ donor was identified as the source of WNV infection by retrospective NAT on serum collected 3 days prior to organ recovery; WNV was detected in mosquitoes in his home county 2 weeks prior to his death.  Kidney recipient B, a 52 year-old female, reported intermittent headache but was afebrile and otherwise asymptomatic; lumbar puncture was not performed. She had evidence of acute WNV infection by NAT on serum and urine collected up to PTD 181.  The liver recipient, a 47 year-old male, was asymptomatic and had serologic evidence of prior flavivirus infection of indeterminate timing.

Conclusion: 

Clinicians should have a high index of suspicion for WNV as a cause of encephalitis in organ transplant patients and report suspected cases to public health departments to enable a prompt public health response.  Donors may be viremic at time of organ recovery and further evaluation is needed to determine if routine screening of organ donors results in a net benefit for transplant outcomes.


Subject Category: O. Transplant infectious diseases

Ingrid B. Weber, MBChB, MMed1, Brian Schwartz, MD2, Eileen C. Farnon, MD3, S. Andrew Josephson, MD2, Angelo M. De Mattos, MD, MPH4, Brian J. Gallay, MD, PhD4, Sean Van Slyck, MPA/HSA, CPTC5, Sharon L. Messenger, PhD6, Cynthia J. Yen, MPH6, Evan M. Bloch, MD, MS7, Clifton P. Drew, DVM, PhD3 and Carol Glaser, DVM, MPVM, MD6, (1)Centers for Disease Control and Prevention, Fort Collins, CO, (2)University of California, San Francisco, San Francisco, CA, (3)Centers for Disease Control and Prevention, Atlanta, GA, (4)University of California, Davis, Sacramento, CA, (5)California Transplant Donor Network, Oakland, CA, (6)California Department of Public Health, Richmond, CA, (7)Blood Systems Research Institute, San Francisco, CA

Disclosures:

I. B. Weber, None

B. Schwartz, None

E. C. Farnon, None

S. A. Josephson, None

A. M. De Mattos, None

B. J. Gallay, None

S. Van Slyck, None

S. L. Messenger, None

C. J. Yen, None

E. M. Bloch, None

C. P. Drew, None

C. Glaser, None

Previous Abstract | Next Abstract >>

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.