Maryland rabies case came from kidney transplant, CDC confirms

A Maryland man who two weeks ago became the state’s first fatal case of rabies in nearly 40 years contracted the infection from a kidney transplant, according to two people familiar with the case.

Three other people--in Georgia, North Carolina and Illinois--received organs from the same donor. They have been located and have started rabies-prevention treatment.

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“They’re doing fine,” Matthew Kuehnert, a physician at the Centers for Disease Control and Prevention, said Friday morning, confirming the case reported earlier by The Washington Post. The CDC is assisting county, state, military and other federal agencies investigating the case.

It is only the third time on record rabies has been transmitted by transplantation of c“solid” organs such as kidneys and livers. A cluster of cases occurred in Texas in 2004 and in Germany in 2005.

The recipient died at the Veterans Affairs Medical Center in Washington after being in the hospital for about a month, according to the people with knowledge of the case, who spoke on the condition of anonymity. He had received a kidney from a Florida man in an operation at the Walter Reed National Military Medical Center in 2011.

CDC laboratory scientists earlier this week determined that the rabies virus obtained from the recipient was genetically identical to the virus recovered from the organ’s donor.

Untreated rabies is almost always fatal. People vaccinated after becoming infected but before symptoms develop usually survive. Richard Franka, director of the CDC’s rabies lab, said that “maybe dozens” of people who had contact with either the donor or recipient will need to get rabies vaccination--a course of four shots. Some have already started.

Transmission of rabies through organ or tissue transplant is extremely rare. Four people in Texas died in 2004 from rabies contracted from a single donor’s tissue. There have been at least eight cases around the world contracted through cornea transplants.

Investigation of the case involves county, state, federal and military epidemiologists, physicians and laboratory scientists.

Rabies was suspected shortly before the recipient’s death but was not confirmed until his brain was examined in an autopsy. The idea that he could have contracted the infection from the transplanted kidney was initially doubted because of the extremely long time — about 15 months — between the surgery and his death. The incubation of rabies cases is rarely longer than three months.

In general, fewer than five cases of rabies are diagnosed each year in the United States. Most often the virus is acquired by contact with a bat. Bites from infected raccoons and dogs, or contact with their saliva, account for most of the rest. How the Florida man may have contracted the infection could not be learned.

The virus travels up nerves to the brain, a process that takes weeks or months if the entry wound is far from the head (as in the foot). Symptoms are varied and occasionally dramatic, such as the fear of swallowing water known as hydrophobia. The patient usually slips into a coma and dies of respiratory failure.