Transmission of Lymphocytic Choriomeningitis Virus by Organ Transplantation
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Author
Fischer, Staci A.
Graham, Mary Beth
Kuehnert, Matthew J.
Srinivasan, Arjun
Comer, James A.
Guarner, Jeannette
Paddock, Christopher D.
Shieh, Wun-Ju
Erickson, Bobbie R.
Bandy, Utpala
Davis, Jeffrey P.
Pavlin, Boris
Likos, Anna
Vincent, Martin J.
Sealy, Tara K.
Goldsmith, Cynthia S.
Jernigan, Daniel B.
Rollin, Pierre E.
Packard, Michelle M.
Patel, Mitesh
Rowland, Courtney
Helfand, Rita F.
Nichol, Stuart T.
Ksiazek, Thomas
Zaki, Sherif R.
Published Version
https://doi.org/10.1056/NEJMoa053240Metadata
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Fischer, Staci A., Mary Beth Graham, Matthew J. Kuehnert, Camille N. Kotton, Arjun Srinivasan, Francisco M. Marty, James A. Comer, et al. 2006. “Transmission of Lymphocytic Choriomeningitis Virus by Organ Transplantation.” New England Journal of Medicine 354 (21) (May 25): 2235–2249. doi:10.1056/nejmoa053240.Abstract
BackgroundIn December 2003 and April 2005, signs and symptoms suggestive of infection devel- oped in two groups of recipients of solid-organ transplants. Each cluster was inves- tigated because diagnostic evaluations were unrevealing, and in each a common do- nor was recognized.
Methods
We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histo- pathological examination with immunohistochemical staining to identify a cause. Epidemiologic investigations, including interviews, environmental assessments, and medical-record reviews, were performed to characterize clinical courses and to determine the cause of the illnesses.
Results
Laboratory testing revealed lymphocytic choriomeningitis virus (LCMV) in all the recipients, with a single, unique strain of LCMV identified in each cluster. In both investigations, LCMV could not be detected in the organ donor. In the 2005 cluster, the donor had had contact in her home with a pet hamster infected with an LCMV strain identical to that detected in the organ recipients; no source of LCMV infection was found in the 2003 cluster. The transplant recipients had abdominal pain, altered mental status, thrombocytopenia, elevated aminotransferase levels, coagulopathy, graft dysfunction, and either fever or leukocytosis within three weeks after transplan- tation. Diarrhea, peri-incisional rash, renal failure, and seizures were variably present. Seven of the eight recipients died, 9 to 76 days after transplantation. One recipient, who received ribavirin and reduced levels of immunosuppressive therapy, survived.
Conclusions
We document two clusters of LCMV infection transmitted through organ trans- plantation.
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