Rabies: new insights into pathogenesis and treatment

Area of Science:

• Virology
• Infectious Diseases
• Transplantation Immunology

Background:

• Rabies virus poses a significant public health threat.
• Organ and vascular conduit transplantation are life-saving procedures.
• Transmission of infectious agents through transplantation is a known risk.

Purpose of the Study:

• To address rabies virus transmission through organ and vascular conduit transplantation.
• To discuss the recovery of a patient from rabies in Wisconsin.
• To provide perspectives on rabies prevention in organ transplantation and patient management.

Main Methods:

• Review of documented cases of rabies transmission via transplantation.
• Analysis of a unique case of rabies survival in a pediatric patient.
• Discussion of clinical recognition, prevention, and management strategies.

Main Results:

• In 2004, organ and vascular conduit transplantation led to seven rabies fatalities in the USA and Germany.
• Rabies virus was likely transmitted through nerves in transplanted organs and arterial segments to immunosuppressed recipients.
• A young patient in Wisconsin survived rabies following a bat bite, without receiving postexposure prophylaxis.

Conclusions:

• Recent rabies virus transmissions underscore the critical need for clinical recognition of rabies in transplant recipients.
• Pre-transplant laboratory screening for rabies in donors presents logistical challenges and risks of false-positive results.
• The survival of a rabies patient offers hope for the development of effective rabies therapies.