ederal and Florida health officials said last night that they were investigating the possibility that a 71-year-old man had developed West Nile fever from a recent organ transplant.Posted on 08/31/2002 4:15:13 AM PDT by JohnHuang2
ederal and Florida health officials said last night that they were investigating the possibility that a 71-year-old man had developed West Nile fever from a recent organ transplant.
Because the man and the organ donor, who died in Georgia, are believed to have received blood transfusions, health officials said they were also investigating whether their blood donors were infected.
If health officials confirm that the man acquired the infection through the organ transplant or a blood transfusion, it would be a new route of transmission of West Nile virus. The possibility that the man acquired his infection through the known means, a mosquito bite, has not been ruled out, officials said.
No case of transmission of West Nile or closely related mosquito-borne virus through blood or organ transplants has been reported in this country, a spokesman for the Centers for Disease Control and Prevention in Atlanta said. The West Nile virus was first detected in this hemisphere in 1999, in New York City.
West Nile virus usually produces its most serious illness among people older than 50 and those whose immune system has been weakened by other diseases or treatment for them. A transplant recipient takes drugs that help prevent rejection of the donated organ but that also suppress the immune system, increasing chances of a severe case in someone who has acquired the virus.
Florida health officials said the man, who was not identified, was a resident of Miami-Dade County and the state's second case of West Nile fever this year. The first case was in a patient who lived in another part of Florida and who had traveled to Louisiana, which is the state most heavily affected this year by the virus.
Dr. John O. Agwunobi, the Florida secretary of health, declined to give details of the new case, like the dates of his transplant and onset of symptoms, to protect the patient's privacy.
Florida officials have performed laboratory tests that confirm the man was infected with the virus. The epidemiologic investigation to determine how the man acquired the infection is in its early stages.
"We always investigate all possibilities in every case, but I don't want to speculate on the cause because that is being investigated," Dr. Agwunobi said in an interview.
Dr. Agwunobi said his department is working with the C.D.C.
Dr. Julie L. Gerberding, the director of the disease centers, said, "We have to take this case seriously and have an open mind about the possibility because transmission of the West Nile virus through blood and organs is biologically plausible." The C.D.C. is responsible for protecting the public's health from infections like West Nile fever.
"Although it is too early in the investigation to determine how the man acquired his infection, a leading hypothesis that we are investigating at this time is that it is related to the organ transplant," Dr. Gerberding said in an interview. "Another, but less likely, possibility is that the man acquired the infection through a blood transfusion."
Scientists have performed statistical analyses that show that transmission of West Nile virus could occur at a very low rate through blood transfusions, Dr. Gerberding said.
If blood donations are confirmed as the source of the man's infection, it would raise questions whether blood banks would need to test blood before it is transfused. Blood banks routinely test for viruses and bacteria that cause hepatitis, AIDS and other infections.
But, Dr. Gerberding said, "the problem is that we do not have a rapid test for West Nile virus," and other tests, such as one known as the PCR (for polymerase chain reaction), are not reliable for screening blood at this time.
"The message I would like to communicate is that this is of concern, we are in the active phase of the investigation, but it is early, and we hope to gain a more precise understanding of exactly how the transmission occurred," she said. "Realistically, I think we will be able to figure this out."
How soon will depend in part on when C.D.C. receives blood samples from the blood donors involved and whether the recipient of the donor's other organs also became infected with West Nile virus.
"We have a lot of work to do, and we are doing it fast," Dr. Gerberding said.
At least 555 additional cases of West Nile fever, including 28 deaths, have been reported to the Centers for Disease Control and Prevention from 26 states and the District of Columbia this year.
The woman, who has not been named by the CDC, donated four of her organs, which were transplanted at various hospitals into four people in Florida and Georgia. One of the transplant recipients, a 71-year-old man, died Aug. 29 of encephalitis, an inflammation of the brain that is the most severe of the virus' possible symptoms. Two of the other recipients appear to have encephalitis, and the fourth has a fever, CDC officials said. James Hughes, director of CDC's National Center for Infectious Diseases, said the organ donor received numerous blood transfusions before she died. He said the CDC hopes to determine from the tests at Fort Collins whether she contracted West Nile virus from those transfusions.
In addition, he said, the CDC and health officials in Georgia and Florida are trying to determine whether the four transplant recipients have the virus and, if so, how they got it. So far, only one of the organ recipients, a Florida man who received the woman's heart, has a confirmed case of the disease. But another recipient, a man who died Aug. 29, tested positive for exposure to Flavi viruses, the family to which West Nile belongs. All 638 known cases of West Nile in the United States this year, including 31 deaths, are believed to have resulted from mosquito bites.***
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