Kidney recipient who died of rabies got organ from Gainesville center
Published: Monday, March 18, 2013 at 7:47 p.m.
Last Modified: Monday, March 18, 2013 at 7:47 p.m.
A patient in Maryland who died earlier this month of rabies from a transplanted kidney that was infected with the virus received the kidney from the LifeQuest Organ Recovery Center in Gainesville.
The patient was one of four organ recipients from the same infected donor, according to information reported Friday by the Centers for Disease Control and Prevention.
"This donor was not tested for rabies as a patient, and he was not suspected of having rabies," said Kathy Giery, director of donor program development at LifeQuest. "If we had suspected rabies, we would have completely ruled out the donation."
Giery said the patient was believed to have had ciguatera, a food-borne illness from reef fish that can cause vomiting and diarrhea, arrhythmias and neurological symptoms like blurred vision.
She added that rabies is not a part of the routine testing of organs that the center recovers for transplantation because it occurs so rarely and the center has never suspected rabies in a donor. The center does test for Hepatitis, HIV and several other conditions, Giery said.
The CDC estimates that one to three cases of rabies in humans occur each year in the U.S. and that cases in organ transplants are extremely rare. The most recent case of rabies because of a transplanted organ occurred in Texas in 2004.
Giery said the transplant program in Maryland that received the donated kidney for the patient who died contacted LifeQuest after his death, and LifeQuest sent the donor's blood sample to the CDC, where rabies was confirmed.
Before the blood was sent to the CDC, LifeQuest contacted the donor's other three organ recipients, Giery said. According to the CDC, those recipients are located in Florida, Georgia and Illinois and are all getting anti-rabies shots.
The donor was a 20-year-old man from North Carolina who had moved to Florida to train as an Air Force aviation mechanic. The Associated Press identified him on Monday as William Edward Small. He died in September 2011 at an undisclosed civilian hospital after first seeking treatment at a clinic at the Pensacola Naval Air Station, the AP reported.
"I think it's one of these things that it is extremely unfortunate," said Dr. Glenn Morris, the director of the Emerging Pathogen Institute at the University of Florida. "It is not surprising that a physician failed to recognize that it was rabies, but one would have hoped that the physician would have picked it up."
Not only is rabies extremely rare in humans, Morris said, but the incubation time is normally one to three months, meaning its symptoms usually appear in that time frame. Initial symptoms are flu-like — a headache and fever for several days — but morph into delirium and hallucinations until a generalized encephalitis, or inflammation of the brain, is typically diagnosed.
Other, more common viruses such as West Nile and Herpes simplex also develop into encephalitis with symptoms similar to rabies, Morris said.
He added that these more common viruses in humans might have made the diagnosis of rabies difficult.
"I can understand if there was nothing to make (the doctor) think of it, particularly a year out. It's not something that would have crossed his mind," Morris said.
The identity of the patient who died has not been disclosed. The patient died in early March, about a year and a half after receiving the donation.
Rabies is normally contracted through an animal bite, and dogs are vaccinated because of their close contact with wild animals and humans, Morris said.
"Rabies continues to be a major risk … An animal that is infected with rabies will aggressively approach and bite everything in sight," Morris said.
Both the donor and recipient had the same type of rabies virus — from a raccoon, the CDC said.
Rabid raccoons especially have carried the virus in Maryland and other Eastern Seaboard states in the past two decades, Morris said.
"Rabies is a very real disease that's present here in Florida," he added. In 2012, Alachua County had six documented animal cases — four in raccoons, one in a bat and one in a dog.
Morris said rabies is a slow-growing disease, so it's possible to be immunized against it once you've been exposed.
"Hopefully, there is still time to prevent the disease in people exposed to transplants," he said.
Giery of LifeQuest said, ""We are reviewing all steps we've taken."
Contact Kristine Crane at 338-3119 or firstname.lastname@example.org.