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June 2005

Fatal Encephalitis Due to Rabies Virus Transmitted by Organ Transplantation

Arch Neurol. 2005;62(6):855-856. doi:10.1001/archneur.62.6.855

In this issue of the ARCHIVES, Burton et al1 describe 4 cases of human-to-human transmission of rabies virus through solid organ and arterial allograft transplantation. Rabies virus has been transmitted through corneal transplantation but not previously through solid organ transplantation. We are well aware of the risk of cytomegalovirus transmission through solid organ transplantation and have become more vigilant about preventing the transmission of West Nile virus through organ transplantation after encephalitis developed in the recipients of organs from a donor who had acquired a West Nile virus infection through a blood transfusion.2 In the report by Burton et al, the donor had abdominal pain, confusion, agitation, and ballistic movements of his trunk. A computed tomography scan of the head demonstrated a small subarachnoid hemorrhage, and his symptoms were attributed to an acute cocaine-induced subarachnoid hemorrhage. The patient required admission to the intensive care unit, where he developed a hypertensive crisis. His temperature increased to 106.5°, and he developed intractable generalized tonic-clonic seizure activity. The patient died with a clinically unsuspected rabies virus infection.

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