Brief report: Lymphocytic choriomeningitis virus transmitted through solid organ transplantation--Massachusetts, 2008
Abstract:
Lymphocytic choriomeningitis virus (LCMV) is a rodent-borne arenavirus found worldwide. House mice (Mus musculus) are the natural reservoir, but LCMV also can infect other wild, pet, and laboratory rodents (e.g., rats, mice, guinea pigs, and hamsters). Humans can be infected through exposure to rodent excreta. Person-to-person transmission has occurred only through maternal-fetal transmission and solid organ transplantation. LCMV infection in humans can be asymptomatic or cause a spectrum of illness ranging from isolated fever to meningitis and encephalitis. Overall case fatality is <1%. Fetal infections can result in congenital abnormalities or death. Immunosuppressed patients, such as organ transplant recipients, can develop fatal hemorrhagic fever-like disease. Transmission of LCMV and an LCMV-like arenavirus via organ transplantation has been documented in three previous clusters. Of 11 recipients described in those clusters, 10 died of multisystem organ failure, with LCMV-associated hepatitis as a prominent feature. The surviving patient was treated with ribavirin (an antiviral with in vitro activity against LCMV) and reduction of immunosuppressive therapy. On April 15, 2008, an organ procurement organization (OPO) notified CDC of severe illness in two kidney transplant recipients from a common donor; at the time of notification, one of the recipients had died. Samples from the donor and both recipients were tested at CDC; on April 22, test results revealed evidence of acute LCMV infection in the donor and both recipients. This report summarizes the results of the subsequent public health investigation.
Insights
Lymphocytic choriomeningitis virus (LCMV) can be transmitted through organ transplantation, leading to severe illness and death in recipients. Prompt diagnosis and treatment, including antivirals and reduced immunosuppression, are crucial for survival.
Area of Science:
- Virology
- Infectious Diseases
- Public Health
Background:
- Lymphocytic choriomeningitis virus (LCMV) is a worldwide rodent-borne arenavirus.
- Human infection occurs via rodent excreta, with rare person-to-person transmission through transplantation or maternal-fetal routes.
- LCMV infection presents a spectrum of illness, from asymptomatic to fatal encephalitis, with higher risk in immunosuppressed individuals.
Purpose of the Study:
- To investigate a cluster of severe illness and death in organ transplant recipients linked to a common donor.
- To identify the causative agent and understand the transmission dynamics of LCMV in the context of organ transplantation.
- To summarize findings from a public health investigation following notification of severe illness in transplant recipients.
Main Methods:
- Notification from an organ procurement organization (OPO) regarding severe illness in two kidney transplant recipients from a single donor.
- Laboratory testing of samples from the donor and both recipients at the Centers for Disease Control and Prevention (CDC).
- Analysis of clinical data and outcomes of the affected transplant recipients.
Main Results:
- Acute LCMV infection was confirmed in the donor and both kidney transplant recipients.
- One of the two recipients died prior to notification, while the other experienced severe illness.
- Previous clusters documented high mortality (10 of 11 recipients) due to LCMV via organ transplantation, often with hepatitis.
Conclusions:
- Organ transplantation can serve as a route for LCMV transmission, posing a significant risk to recipients.
- Prompt identification and management, potentially including ribavirin and reduced immunosuppression, may improve outcomes.
- This case underscores the importance of donor screening and vigilance for LCMV in transplant recipients.
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