LCMV infection

Just in case you didn't read it and get questions about it!
More information about this disease at http://www.cdc.gov/healthypets/lcmv_rodents.htm

Lymphocytic Choriomeningitis Virus Infection in Organ Transplant Recipients --- Massachusetts, Rhode Island, 2005

On May 3, 2005, CDC received a report of severe illness in four patients who had received solid organ transplants from a common donor. All four organ recipients subsequently were found to have evidence of infection with lymphocytic choriomeningitis virus (LCMV), a rodent-borne Old World arenavirus. Preliminary findings from the ensuing investigation indicate the source of infection likely was an infected hamster in the donor's home. This report summarizes the ongoing investigation and provides information on exposure risks and possible prevention measures.

In early April, in Rhode Island, a woman with a medical history remarkable only for hypertension and 1 week of headache had sudden onset of hemiplegia caused by a stroke, followed by brainstem herniation and brain death within 3 days. A thorough evaluation was not suggestive of infection.

Family members of the woman consented to donation; organs and tissues were recovered, including the liver, the lungs, both kidneys, both corneas, and skin. Within 3 weeks after transplantation, the four persons who received the liver, lungs, and two kidneys had abnormalities of liver function and blood coagulation, and dysfunction of the transplanted organ. Signs, symptoms, and clinical laboratory test results varied in these patients and included fever, localized rash, diarrhea, hyponatremia, thrombocytopenia, hypoxia, and kidney failure. Three of the four organ recipients died, 23--27 days after transplantation. The fourth patient, a kidney recipient, survived. Histopathologic findings varied in the four cases, but hepatocellular necrosis was common to all three decedents on autopsy. The two cornea recipients were asymptomatic. Skin was not transplanted.

When the cause of illness among the recipients was not identified through extensive diagnostic testing and suspicion of transplant-transmitted infection arose, tissue and blood samples from the donor and recipients were sent from the Rhode Island Department of Health and the Massachusetts Department of Public Health to CDC. LCMV was identified as the cause of illness in all four organ recipients; diagnosis was made in tissues from multiple organs through immunohistochemical staining, reverse transcriptase-polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assays (i.e., IgM capture and indirect IgG), and viral culture on Vero E6 cells. Sequencing of the virus genome confirmed its identity as LCMV. Based on the diagnosis of LCMV infection, the surviving kidney transplant recipient was treated with intravenous ribavirin and reduction in his immunosuppressive drug regimen; the patient improved clinically