Raccoon-Bit Rabid Dead Man Indirectly Kills Another

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How can a dead person indirectly lead to the fatality of another human? By donating a rabies-infected organ, according to a new study in JAMA.

The discovery demonstrates that certain viruses can live for long periods in human organs, even when the individual is long gone.

In this particular case, an individual received a kidney transplant in 2011. In February 2013, some 18 months after the transplant, the person mysteriously died from rabies after having no reported exposures to potentially rabid animals.

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Neil M. Vora of the Centers for Disease Control and Prevention in Atlanta and his colleagues next conducted a study to see if the organ transplantation was the source of the rabies virus exposure in the kidney recipient. Previously, the person who originally had the kidneys was not known to have perished from the disease.

Sure enough, the kidney donor’s symptoms prior to death were consistent with rabies. The presumed diagnosis at the time of death was ciguatera poisoning, which is a foodborne illness.

Interviews with family members of the kidney donor revealed that this individual had significant wildlife exposure and had sustained at least two raccoon bites for which he did not seek medical care. The rabies virus antigen was found in archived autopsy brain tissue collected from the dead man’s body.

Three other individuals received organs from the man. Thankfully, these patients have not shown any symptoms of rabies, suggesting that the kidneys might be more likely to hold living viruses.

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“This transmission event provides an opportunity for enhancing rabies awareness and recognition and highlights the need for a modified approach to organ donor screening and recipient monitoring for infectious encephalitis,” Vora and his colleagues wrote.

In an accompanying editorial, Daniel R. Kaul of the University of Michigan Medical School added:

“Educational efforts to improve recognition of donors with CNS (central nervous system) infection and the risks associated with using these donors should be directed not just at the transplant community but at the larger community of physicians involved in the care of potential donors — particularly critical care specialists, neurologists, and infectious disease physicians.”

It’s a lesson to take care around wild animals. The case also underscores the importance of supporting healthy ecosystems. When animals are healthy to begin with and are not fighting over resources, transmission of viruses among themselves decreases.

(Image: Bastique/Wikimedia Commons)