Was rabies considered?
“Not to our knowledge,” Kuehnert said. “The patient was not tested for rabies either during clinical care or after death at autopsy.” He added that it “is not unusual for rabies not to be thought of in a patient with encephalitis. It is a very rare disease.”
A microscopic examination of brain tissue might have revealed changes characteristic of rabies. By then, however, one kidney had been transplanted into a 48-year-old Army veteran in an operation at Walter Reed Military Medical Center. Three other organs — another kidney, the liver and the heart — were transplanted into patients in Georgia, North Carolina and Illinois.
Kuehnert said Friday all of them have been found and have started treatment, which consists of an injection of rabies-fighting antibodies and four vaccination shots over a month.
“They’re doing fine,” he said.
People exposed to the two men are also being tracked down. “Maybe dozens” will need to be vaccinated too, Franka said.
Rabies was not initially suspected in the Maryland man, either.
He’d gone to the Veterans Affairs hospital in Washington with stomach complaints and then developed weakness and confusion. He died after three weeks on a ventilator. His blood tested positive for rabies antibodies, but other tests were negative. Testing of the brain tissue proved for certain he had the infection.
Even once rabies was suspected, the man’s physicians doubted he could have gotten it from the kidney he’d received 15 months earlier, investigators said. That’s because rabies symptoms rarely appear more than three months after a person is infected (usually by an animal bite).
The airman’s case appears to have had a long incubation period too — at least four months. Kuehnert said such long incubation could be a property of the subtype of virus the men had.
A spokesman for UNOS, Joel Newman, said there are 74,851 “active candidates” for organ transplant in the United States. About 58,000 need kidneys. Most will be on the list for at least four years before they get an organ. Last year, 5,996 people died awaiting organs, most of them awaiting kidneys.