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BACKGROUND: On April 26, 2013, the United Network for Organ Sharing contacted the Centers for Disease Control and Prevention (CDC) to report a cluster of sick organ transplant recipients in Iowa that had received organs from the same donor. The suspected causative agent was lymphocytic choriomeningitis virus (LCMV), a rodent-borne arenavirus which most commonly causes non-fatal flu-like illness with occasional aseptic meningitis, but when transmitted through organ transplantation or congenitally can cause severe, life-threatening disease.
METHODS: Diagnostic specimens were tested at CDC via immunohistochemistry (IHC), Reverse-Transcription Polymerase Chain Reaction (RT-PCR), and IgM and IgG serology. Epidemiologic investigations were conducted of the donor’s exposure history, and of possible laboratory staff exposures. The location and outcome of all harvested organs and tissues were traced.
RESULTS: The organ donor was a 49-year old male found unresponsive in his home following complaints of headache and vomiting, and died due to intracerebral hemorrhage. He had no definitive evidence of rodent exposure. Donor liver, kidneys, and one cornea were transplanted into four recipients on March 26, 2013. Between April 12–16 the three liver and kidney recipients were hospitalized with symptoms including fever, abdominal pain, diarrhea, altered mental status, respiratory compromise, pancytopenia, and elevated liver enzymes. An old world arenavirus was identified in liver biopsies from two recipients by IHC, and LCMV was identified by RT-PCR in various tissues from those recipients and the donor. All three sick recipients developed IgM antibodies. The asymptomatic cornea recipient tested negative for LCMV. On May 11, the liver recipient died. Both kidney recipients survived with mild persistent memory deficits, and one suffered allograft failure not directly caused by LCMV. All non-transplanted donor organs and tissues were destroyed or sent to CDC, including plasma donated two days before death. No significant exposures in laboratory staff were identified.
CONCLUSIONS: The reported cluster is the fifth LCMV organ transplant-associated cluster documented in the United States, with 14 LCMV-infected organ recipients, including 11 deaths, previously described. The three previous cornea recipients also did not develop LCMV infections. Physicians and public health practitioners should be aware that organ donors with meningitis/encephalitis, and some without evidence of an infectious disease process, could be infected with LCMV – especially when rodent exposure has occurred. Testing for LCMV should be considered in organ recipients that develop febrile illness, neurologic changes, or multi-organ dysfunction in the early post-transplant period, especially if multiple recipients from the same donor fall ill.