- The Washington Times - Saturday, October 15, 2005

Two patients who underwent liver and lung transplants from a common donor developed encephalitis and remain comatose after they were infected with West Nile virus, federal health officials said Friday.

Infection by the virus also was confirmed in a third patient, who received a kidney from the same donor in late August, according to a report in the current issue of the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC), but CDC investigators said the third transplant recipient has remained asymptomatic.

A fourth patient, who also received a kidney from the donor, escaped infection, CDC epidemiologists reported.

These were the second reports of West Nile virus (WNV) transmission associated with organ transplants since 2001. An editorial note attached to the report said the previous cases occurred in August 2002, when four transplant recipients infected with the virus all became ill.

In the earlier cases, editors said, the donor whose organs the four patients received mistakenly was given a transfusion of West Nile virus-positive blood the day before the transplants.

But the organ donor responsible for the recent rash of West Nile-related illnesses in transplant recipients “was likely infected via a mosquito bite,” according to the report.

At its worst, West Nile can cause severe, even fatal, neurological impairment. A transplant patient in New York who received the donor’s lungs and a second in Pittsburgh, who received his liver, experienced “severe WNV encephalitis and acute flaccid paralysis with respiratory failure” after the surgeries, the CDC scientists said.

They said the two patients were administered an experimental brain drug, but they have not shown improvement and remain unconscious. The first kidney recipient also has received the experimental treatment and remains healthy.

Researchers were not shocked to find that West Nile was responsible for the ailing organ transplant patients. They said studies have shown that organ recipients have a 40 times greater risk than the general population of developing “neuroinvasive disease after WNV infection.”

Neuroinvasive disease refers to severe virus-related diseases, particularly West Nile encephalitis and West Nile meningitis.

Investigators said the reason transplant patients and other immune-suppressed persons are at higher risk for the gravest West Nile-related illnesses is because they have prolonged incubation periods.

Given these findings, they said: “Clinicians should be aware of the potential for transplant-associated transmission of infectious diseases.”

The latest CDC data tally 2,148 human cases of West Nile virus in the United States this year, including 59 deaths.

California leads the nation so far this year in both the number of human West Nile cases (771) and deaths (16). In 2004, there were 2,539 human cases of West Nile cases nationally and 100 deaths, the CDC said.



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