Solid Organ Transplant–associated Lymphocytic Choriomeningitis, United States, 2011 - Vol. 18 No. 8 - August 2012 - Emerging Infectious Disease journal - CDC

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Solid Organ Transplant–associated Lymphocytic Choriomeningitis, United States, 2011 - Vol. 18 No. 8 - August 2012 - Emerging Infectious Disease journal - CDC
 
Viruses articles
Volume 18, Number 8–August 2012

Volume 18, Number 8—August 2012

Research

Solid Organ Transplant–associated Lymphocytic Choriomeningitis, United States, 2011

Article Contents

• Methods
• Results
• Discussion
• Acknowledgments
• References
• Figure 1
• Figure 2
• Table 1
• Table 2
• Suggested Citation

Adam MacNeil , Ute Ströher, Eileen Farnon, Shelley Campbell, Deborah Cannon, Christopher D. Paddock, Clifton P. Drew, Matthew Kuehnert, Barbara Knust, Robert Gruenenfelder, Sherif R. Zaki, Pierre E. Rollin, Stuart T. Nichol, and the LCMV Transplant Investigation Team

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A. MacNeil, U. Ströher, E. Farnon, S. Campbell, D. Cannon, C.D. Paddock, C.P. Drew, M. Kuehnert, B. Knust, S.R. Zaki, P.E. Rollin, S.T. Nichol); and Arkansas Organ Recovery Agency, Little Rock, Arkansas, USA (R. Gruenenfelder)

Suggested citation for this article

Abstract

Three clusters of organ transplant–associated lymphocytic choriomeningitis virus (LCMV) transmissions have been identified in the United States; 9 of 10 recipients died. In February 2011, we identified a fourth cluster of organ transplant–associated LCMV infections. Diabetic ketoacidosis developed in the organ donor in December 2010; she died with generalized brain edema after a short hospitalization. Both kidneys, liver, and lung were transplanted to 4 recipients; in all 4, severe posttransplant illness developed; 2 recipients died. Through multiple diagnostic methods, we identified LCMV infection in all persons, including in at least 1 sample from the donor and 4 recipients by reverse transcription PCR, and sequences of a 396-bp fragment of the large segment of the virus from all 5 persons were identical. In this cluster, all recipients developed severe illness, but 2 survived. LCMV infection should be considered as a possible cause of severe posttransplant illness.

Lymphocytic choriomeningitis virus (LCMV), an Old World arenavirus, family Arenaviridae, is a zoonotic virus maintained in the house mouse (Mus musculus) and can be carried by pet and laboratory rodents (1–7); human exposure occurs through aerosolized excreta or by direct rodent contact. Infection in immunocompetent humans most commonly results in nonspecific febrile illness, although aseptic meningitis develops in a subset of persons (8). Person-to-person transmission of LCMV is unusual and has been reported only through vertical transmission from a pregnant woman to her fetus and through solid organ transplantation. In both instances, infections are associated severe disease. For instance, congenital infection can result in birth defects, including hydrocephalus and chorioretinitis (9–12), and transplant recipient infection can result in multisystem organ failure. Three previous clusters of organ transplant–transmitted LCMV infections have been identified in the United States, affecting 10 organ recipients, 9 of whom died (13,14).

Figure 1

Figure 1. . . . Liver from a 62-year-old woman (lung transplant patient) showing acute necrosis of hepatocytes and minimal inflammation. Randomly distributed single-cell necrosis, as observed in this patient, is a histopathologic...

In February 2011, the Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA) was notified of a cluster of severe illnesses (2 fatal, and 2 in persons who were recovering) among 4 organ recipients linked to 1 donor, who died in late December 2010. Postmortem evaluation of the donor showed only evidence of previous Epstein-Barr virus infection. CDC acquired multiple specimens from the donor and recipients for testing. Histopathologic findings showed multifocal hepatocellular necrosis (Figure 1) in the lung transplant recipient, and Old World arenavirus antigens subsequently were identified by immunohistochemical testing (IHC). Reverse transcription PCR (RT-PCR) and sequencing indicated LCMV infection. Subsequent testing of specimens from the donor and recipients confirmed LCMV infection in all 5 persons, marking the fourth detected cluster of transplant-associated LCMV transmissions in the United States. We describe the laboratory investigation and clinical outcomes of this recent cluster of transplant-transmitted LCMV infections (Table 1).