Transmission of lymphocytic choriomeningitis virus by organ transplantation

Staci A. Fischer, Mary Beth Graham, Matthew J. Kuehnert, Camille N. Kotton, Arjun Srinivasan, Francisco M. Marty, James A. Comer, Jeannette Guarner, Christopher D. Paddock, Dawn L. DeMeo, Wun Ju Shieh, Bobbie R. Erickson, Utpala Bandy, Alfred DeMaria, Jeffrey P. Davis, Francis L. Delmonico, Boris Pavlin, Anna Likos, Martin J. Vincent, Tara K. SealyCynthia S. Goldsmith, Daniel B. Jernigan, Pierre E. Rollin, Michelle M. Packard, Mitesh Patel, Courtney Rowland, Rita F. Helfand, Stuart T. Nichol, Jay A. Fishman, Thomas Ksiazek, Sherif R. Zaki

Research output: Contribution to journalArticle

353 Citations (Scopus)

Abstract

Background: In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were unrevealing, and in each a common donor was recognized. Methods: We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histopathological 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 transplantation. 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 transplantation.

Original languageEnglish (US)
Pages (from-to)2235-2249
Number of pages15
JournalNew England Journal of Medicine
Volume354
Issue number21
DOIs
StatePublished - May 25 2006
Externally publishedYes

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Lymphocytic choriomeningitis virus
Organ Transplantation
Tissue Donors
Virus Diseases
Transplantation
Transplants
Ribavirin
Pets
Leukocytosis
Immunosuppressive Agents
Transaminases
Exanthema
Cricetinae
Thrombocytopenia
Abdominal Pain
Signs and Symptoms
Medical Records
Renal Insufficiency
Diarrhea
Electron Microscopy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fischer, S. A., Graham, M. B., Kuehnert, M. J., Kotton, C. N., Srinivasan, A., Marty, F. M., ... Zaki, S. R. (2006). Transmission of lymphocytic choriomeningitis virus by organ transplantation. New England Journal of Medicine, 354(21), 2235-2249. https://doi.org/10.1056/NEJMoa053240

Transmission of lymphocytic choriomeningitis virus by organ transplantation. / Fischer, Staci A.; Graham, Mary Beth; Kuehnert, Matthew J.; Kotton, Camille N.; Srinivasan, Arjun; Marty, Francisco M.; Comer, James A.; Guarner, Jeannette; Paddock, Christopher D.; DeMeo, Dawn L.; Shieh, Wun Ju; Erickson, Bobbie R.; Bandy, Utpala; DeMaria, Alfred; Davis, Jeffrey P.; Delmonico, Francis L.; 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.; Fishman, Jay A.; Ksiazek, Thomas; Zaki, Sherif R.

In: New England Journal of Medicine, Vol. 354, No. 21, 25.05.2006, p. 2235-2249.

Research output: Contribution to journalArticle

Fischer, SA, Graham, MB, Kuehnert, MJ, Kotton, CN, Srinivasan, A, Marty, FM, Comer, JA, Guarner, J, Paddock, CD, DeMeo, DL, Shieh, WJ, Erickson, BR, Bandy, U, DeMaria, A, Davis, JP, Delmonico, FL, Pavlin, B, Likos, A, Vincent, MJ, Sealy, TK, Goldsmith, CS, Jernigan, DB, Rollin, PE, Packard, MM, Patel, M, Rowland, C, Helfand, RF, Nichol, ST, Fishman, JA, Ksiazek, T & Zaki, SR 2006, 'Transmission of lymphocytic choriomeningitis virus by organ transplantation', New England Journal of Medicine, vol. 354, no. 21, pp. 2235-2249. https://doi.org/10.1056/NEJMoa053240
Fischer SA, Graham MB, Kuehnert MJ, Kotton CN, Srinivasan A, Marty FM et al. Transmission of lymphocytic choriomeningitis virus by organ transplantation. New England Journal of Medicine. 2006 May 25;354(21):2235-2249. https://doi.org/10.1056/NEJMoa053240
Fischer, Staci A. ; Graham, Mary Beth ; Kuehnert, Matthew J. ; Kotton, Camille N. ; Srinivasan, Arjun ; Marty, Francisco M. ; Comer, James A. ; Guarner, Jeannette ; Paddock, Christopher D. ; DeMeo, Dawn L. ; Shieh, Wun Ju ; Erickson, Bobbie R. ; Bandy, Utpala ; DeMaria, Alfred ; Davis, Jeffrey P. ; Delmonico, Francis L. ; 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. ; Fishman, Jay A. ; Ksiazek, Thomas ; Zaki, Sherif R. / Transmission of lymphocytic choriomeningitis virus by organ transplantation. In: New England Journal of Medicine. 2006 ; Vol. 354, No. 21. pp. 2235-2249.
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abstract = "Background: In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were unrevealing, and in each a common donor was recognized. Methods: We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histopathological 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 transplantation. 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 transplantation.",
author = "Fischer, {Staci A.} and Graham, {Mary Beth} and Kuehnert, {Matthew J.} and Kotton, {Camille N.} and Arjun Srinivasan and Marty, {Francisco M.} and Comer, {James A.} and Jeannette Guarner and Paddock, {Christopher D.} and DeMeo, {Dawn L.} and Shieh, {Wun Ju} and Erickson, {Bobbie R.} and Utpala Bandy and Alfred DeMaria and Davis, {Jeffrey P.} and Delmonico, {Francis L.} and Boris Pavlin and Anna Likos and Vincent, {Martin J.} and Sealy, {Tara K.} and Goldsmith, {Cynthia S.} and Jernigan, {Daniel B.} and Rollin, {Pierre E.} and Packard, {Michelle M.} and Mitesh Patel and Courtney Rowland and Helfand, {Rita F.} and Nichol, {Stuart T.} and Fishman, {Jay A.} and Thomas Ksiazek and Zaki, {Sherif R.}",
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T1 - Transmission of lymphocytic choriomeningitis virus by organ transplantation

AU - Fischer, Staci A.

AU - Graham, Mary Beth

AU - Kuehnert, Matthew J.

AU - Kotton, Camille N.

AU - Srinivasan, Arjun

AU - Marty, Francisco M.

AU - Comer, James A.

AU - Guarner, Jeannette

AU - Paddock, Christopher D.

AU - DeMeo, Dawn L.

AU - Shieh, Wun Ju

AU - Erickson, Bobbie R.

AU - Bandy, Utpala

AU - DeMaria, Alfred

AU - Davis, Jeffrey P.

AU - Delmonico, Francis L.

AU - Pavlin, Boris

AU - Likos, Anna

AU - Vincent, Martin J.

AU - Sealy, Tara K.

AU - Goldsmith, Cynthia S.

AU - Jernigan, Daniel B.

AU - Rollin, Pierre E.

AU - Packard, Michelle M.

AU - Patel, Mitesh

AU - Rowland, Courtney

AU - Helfand, Rita F.

AU - Nichol, Stuart T.

AU - Fishman, Jay A.

AU - Ksiazek, Thomas

AU - Zaki, Sherif R.

PY - 2006/5/25

Y1 - 2006/5/25

N2 - Background: In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were unrevealing, and in each a common donor was recognized. Methods: We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histopathological 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 transplantation. 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 transplantation.

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