Ch13

Viral Infection in Organ Transplantation: 

Viral Infection in Organ Transplantation Jay A. Fishman, MD Transplant and Compromised Host Program Infectious Disease Division Massachusetts General Hospital Harvard Medical School Boston, Massachusetts, USA

Viral Infection in Organ Transplantation: 

Viral Infection in Organ Transplantation Jay A. Fishman, MD Transplant and Compromised Host Program Infectious Disease Division Massachusetts General Hospital Harvard Medical School Boston, Massachusetts, USA

Slide3: 

These materials, slides, and textual information are copyrighted by the Massachusetts General Hospital and the General Hospital Corporation, Boston, Massachusetts, 2005.

West Nile Virus: 

West Nile Virus

West Nile Virus: 

West Nile Virus Flavivirus (family of Japanese viral encephalitis arboviruses) first isolated in Uganda in 1937 Peak incidence in late summer, early fall; transmitted by mosquitoes (Culex species) Carried by migratory birds to local birds, marsh and Culex (house) mosquitoes

West Nile Virus: Epidemiology: 

West Nile Virus: Epidemiology Worldwide distribution except North America until 1999 6% of children and 40% of adults in Egypt Outbreaks in close quarters (eg, 60% seropositive in Congo military camp, 10% controls) in Israel and Africa Common, usually mild disease but with occasional outbreaks with severe neurologic disease (meningoencephalitis) with ~10% mortality Severe complications uncommon 62 cases and 7 deaths in New York City in 1999 (by genetics, imported from Middle East)—probably >200,000 infected in United States 42 states in United States in September 2002 involving >2000 cases; 50 states by 2004.

West Nile Virus: Life Cycle: 

West Nile Virus: Life Cycle Wild birds develop high-level viremia and amplify infection but are generally asymptomatic. Mortality among birds is uncommon prior to recent outbreaks. In a recent outbreak, mortality occurred in >130 species of native and captive birds (crows, ravens, jays) in North America Basic transmission cycle involves mosquitoes feeding on birds infected with the virus When taking a blood meal, infected mosquitoes then transmit West Nile virus to humans and animals. Mammals (humans, horses, dogs) are incidental hosts with lower-level viremia—not major reservoirs

West Nile Fever: Classic Clinical Description: 

West Nile Fever: Classic Clinical Description Asymptomatic or mild dengue-like illness Fever, lymphadenopathy, headache, abdominal pain, vomiting, rash, conjunctivitis Incubation period usually 5 to 15 days CNS involvement and death in minority of cases CNS, central nervous system.

West Nile Virus in Recipients of Organ Transplants or Blood Transfusions : 

West Nile Virus in Recipients of Organ Transplants or Blood Transfusions Suspected West Nile virus – associated encephalitis (meningoencephalitis) within 4 weeks after receiving organ transplants or blood products All patients resided in areas with epidemic and epizootic West Nile virus activity Four organs from a single organ donor were transplanted into 4 persons. West Nile virus–associated encephalitis was confirmed in 3 recipients and West Nile virus fever in 1 recipient. The CDC investigation demonstrated transmission from a West Nile virus–viremic organ donor to recipients of those organs CDC, Centers for Disease Control and Prevention.

West Nile Virus in Transplantation: 

West Nile Virus in Transplantation Illness began 7 to 17 days after transplantation. The donor's plasma was positive for West Nile virus by quantitative PCR assay at the time of the organ recovery PCR, polymerase chain reaction.

West Nile Virus in Transplantation: 

West Nile Virus in Transplantation West Nile virus can survive in some blood components and can probably be transmitted by transfusion Not all recipients of potentially West Nile virus–contaminated blood will become infected with West Nile virus, but more common in transplant recipients Susceptibility to viral infection appears to play a role in risk for West Nile virus infection. Suspicion during epidemic periods must prompt evaluation; therapy must include reduction in intensity of immune suppression