justme23
07-01-2004, 09:36 PM
Rabies in donor organs kills 3
Baylor patients received kidneys, liver from man who died of disease
10:26 PM CDT on Thursday, July 1, 2004
By SHERRY JACOBSON / The Dallas Morning News
Three transplant patients at Baylor University Medical Center at Dallas died of rabies last month, the first time the disease has been transmitted by donated organs, the U.S. Centers for Disease Control and Prevention announced Thursday.
"The CDC confirmed yesterday that all three patients were infected with a strain of rabies commonly found in bats," said Dr. Mitchell Cohen, the CDC's director of the coordinating center for infectious diseases. "This is a very sad and tragic situation, especially for the families that have lost a loved one."
Rabies not on testing list before organ transplants
The victims, who were not named, received the infected organs May 4 from an unidentified Arkansas man who had died at a Texarkana hospital the previous day. Doctors mistakenly thought the man had suffered a brain hemorrhage, but the CDC concluded Wednesday after extensive testing that the donor and three of his organ recipients died from rabies, a disease for which donated organs are never tested.
The families of the three Baylor patients were notified Thursday of the findings by the surgeons who had performed their transplants, said Dr. Bill Sutker, the medical center's chief of infectious diseases.
"We never suspected it was rabies," he said. "I've never even seen rabies in the 25 years I've been involved in infectious diseases. It's not something that's expected or should have been expected."
Once symptoms occur, rabies is almost always fatal.
The rabies victims included two patients from Texas, each of whom received a kidney from the man, and a third patient from Oklahoma, who received his liver. A fourth organ recipient, who received the man's lungs, died during a May 4 transplant operation at the University of Alabama at Birmingham Hospital. That death was considered unrelated to rabies, the CDC said.
Human rabies rare
Federal and local health officials struggled Thursday to explain how the rabies could have been transmitted – in an age when the screening of donated blood and organs for a variety of viruses has become a common safety procedure.
"Human rabies is extremely rare, and we see only a few human cases each year," Dr. Cohen said. "It is usually in people who are bitten or scratched by certain types of bats, and who usually don't know it."
The organ donation service in Dallas that oversaw the transplant case said there was no way to suspect that the donor had rabies.
"We visited with his family and asked them a bunch of health-related questions," said Pam Silvestri of Southwest Transplant Alliance. "The questions are only good if the people know the answers."
Rabies tests are not done because it takes too long to get results that would allow a dying patient's organs to be donated in a timely way. Normally, the organs are removed within six hours of a family giving its approval.
"There's no way to test for rabies in such a short period of time," said Ms. Silvestri, public education director for the transplant service, which provides organs to 10 hospitals, including Baylor. "It took the CDC more than a week to get a positive test result on these cases. We could never wait that long." Because the four patients, including the organ donor, developed full-blown rabies symptoms, local health officials want to be certain their families were not infected by the disease. They will be interviewed about possible exposures, including something as simple as a kiss, which theoretically could transmit the rabies virus. However, the chances of it happening that way are remote.
Workers to be screened
Likewise, hundreds of health-care workers at five medical centers in four states who had contact with the patients, including those at Baylor, also must be screened for possible exposure to rabies. They will include nurses, doctors and technicians who came into contact with any of the four transplant patients, the donor or the organs that were transplanted.
Dr. Sutker said Baylor employees will fill out questionnaires to pinpoint any possible exposure to the saliva or spinal fluid of any of the four patients. Persons can't be exposed to rabies by contact with blood. Those at highest risk will be asked to undergo a series of shots to prevent rabies if they were infected.
Such accidental transmissions are highly unlikely, Dr. Sutker said.
"There have been only eight reported cases of human-to-human transmission," he said. "Seven were in people who received cornea transplants from people who were infected with rabies. Only one of those cases was in the United States."
The eighth documented case of human transmission of rabies was through a bite.
Dr. Cohen agreed that the risk of rabies spreading from person to person was remote.
"Transmission from an infected patient to health-care providers has never been documented," Dr. Cohen said, but conceded that some people might be alarmed at the possibility. Health care officials said they struggled to understand the sequence of events that led to the unexpected deaths.
Donor's treatment
It started with the donor, who sought treatment at Wadley Regional Medical Center in Texarkana, Texas, the morning of April 28, said Shelby Brown, director of the hospital's marketing and planning.
"The person was treated and released," she said Thursday, but declined to give further information about the man's condition, citing the new Health Insurance Privacy and Portability Act that now closes specific patient information to the public.
She would only say that the man "was treated for symptoms not related to rabies or rabies exposure."
That same day, he sought treatment at CHRISTUS St. Michael Health Care Center's emergency room after leaving Wadley, complaining of nausea and vomiting, said Francine Francis, marketing communication manager for the Texarkana hospital.
The man was admitted to St. Michael's intensive care unit in the early morning hours of April 29 and died May 3, Ms. Francis said.
The donor never mentioned anything about animal bites or being exposed to rabies, she said.
Ms. Francis declined to answer questions about what initial diagnosis St. Michael's doctors made or the man's cause of death.
Ms. Francis said she did not know if the donor carried an organ donor card before he died or whether his family made the decision to donate his organs.
An autopsy was probably not performed, she said, because so much screening of the organs occurred prior to harvesting them.
Dr. Sutker said the medical staff at Baylor transplanted the organs on May 4 and considered the operations to be successful.
"They all went home after a normal amount of recovery time," he recalled.
The first suggestion that something had gone wrong came in late May. Two of the patients were readmitted to Baylor between May 25 and May 29, he said. One appeared to be suffering organ rejection, and the other appeared to have a medication-related problem.
"Infection was not suspected," he said. "Eventually, they began to develop neurologic problems, starting with confusion and headache, and eventually deteriorating from there."
The third recipient sought care May 30 at Longview's Good Shepherd Medical Center's emergency room, according to a news release issued by the hospital Thursday. The patient was treated for about 19 hours before the staff decided a transfer was needed back to Baylor.
"Sooner or later, all three of them ended up" in the intensive care unit, Dr. Sutker said. "We said, 'Something is going on here. All these patients received organs from the same donor.'"
The patients underwent a variety of tests trying to determine the underlying cause of their illness. But nothing was found, he said. Finally, they started dying.
The patient with the liver transplant died first on June 7, followed by the other two on June 8 and June 21. Because the cause of their deaths was unknown, the CDC was asked to investigate to determine whether there was a common infectious agent, Dr. Sutker said.
"We never expected rabies," he said. "It has never happened before, and it probably never will again."
Baylor patients received kidneys, liver from man who died of disease
10:26 PM CDT on Thursday, July 1, 2004
By SHERRY JACOBSON / The Dallas Morning News
Three transplant patients at Baylor University Medical Center at Dallas died of rabies last month, the first time the disease has been transmitted by donated organs, the U.S. Centers for Disease Control and Prevention announced Thursday.
"The CDC confirmed yesterday that all three patients were infected with a strain of rabies commonly found in bats," said Dr. Mitchell Cohen, the CDC's director of the coordinating center for infectious diseases. "This is a very sad and tragic situation, especially for the families that have lost a loved one."
Rabies not on testing list before organ transplants
The victims, who were not named, received the infected organs May 4 from an unidentified Arkansas man who had died at a Texarkana hospital the previous day. Doctors mistakenly thought the man had suffered a brain hemorrhage, but the CDC concluded Wednesday after extensive testing that the donor and three of his organ recipients died from rabies, a disease for which donated organs are never tested.
The families of the three Baylor patients were notified Thursday of the findings by the surgeons who had performed their transplants, said Dr. Bill Sutker, the medical center's chief of infectious diseases.
"We never suspected it was rabies," he said. "I've never even seen rabies in the 25 years I've been involved in infectious diseases. It's not something that's expected or should have been expected."
Once symptoms occur, rabies is almost always fatal.
The rabies victims included two patients from Texas, each of whom received a kidney from the man, and a third patient from Oklahoma, who received his liver. A fourth organ recipient, who received the man's lungs, died during a May 4 transplant operation at the University of Alabama at Birmingham Hospital. That death was considered unrelated to rabies, the CDC said.
Human rabies rare
Federal and local health officials struggled Thursday to explain how the rabies could have been transmitted – in an age when the screening of donated blood and organs for a variety of viruses has become a common safety procedure.
"Human rabies is extremely rare, and we see only a few human cases each year," Dr. Cohen said. "It is usually in people who are bitten or scratched by certain types of bats, and who usually don't know it."
The organ donation service in Dallas that oversaw the transplant case said there was no way to suspect that the donor had rabies.
"We visited with his family and asked them a bunch of health-related questions," said Pam Silvestri of Southwest Transplant Alliance. "The questions are only good if the people know the answers."
Rabies tests are not done because it takes too long to get results that would allow a dying patient's organs to be donated in a timely way. Normally, the organs are removed within six hours of a family giving its approval.
"There's no way to test for rabies in such a short period of time," said Ms. Silvestri, public education director for the transplant service, which provides organs to 10 hospitals, including Baylor. "It took the CDC more than a week to get a positive test result on these cases. We could never wait that long." Because the four patients, including the organ donor, developed full-blown rabies symptoms, local health officials want to be certain their families were not infected by the disease. They will be interviewed about possible exposures, including something as simple as a kiss, which theoretically could transmit the rabies virus. However, the chances of it happening that way are remote.
Workers to be screened
Likewise, hundreds of health-care workers at five medical centers in four states who had contact with the patients, including those at Baylor, also must be screened for possible exposure to rabies. They will include nurses, doctors and technicians who came into contact with any of the four transplant patients, the donor or the organs that were transplanted.
Dr. Sutker said Baylor employees will fill out questionnaires to pinpoint any possible exposure to the saliva or spinal fluid of any of the four patients. Persons can't be exposed to rabies by contact with blood. Those at highest risk will be asked to undergo a series of shots to prevent rabies if they were infected.
Such accidental transmissions are highly unlikely, Dr. Sutker said.
"There have been only eight reported cases of human-to-human transmission," he said. "Seven were in people who received cornea transplants from people who were infected with rabies. Only one of those cases was in the United States."
The eighth documented case of human transmission of rabies was through a bite.
Dr. Cohen agreed that the risk of rabies spreading from person to person was remote.
"Transmission from an infected patient to health-care providers has never been documented," Dr. Cohen said, but conceded that some people might be alarmed at the possibility. Health care officials said they struggled to understand the sequence of events that led to the unexpected deaths.
Donor's treatment
It started with the donor, who sought treatment at Wadley Regional Medical Center in Texarkana, Texas, the morning of April 28, said Shelby Brown, director of the hospital's marketing and planning.
"The person was treated and released," she said Thursday, but declined to give further information about the man's condition, citing the new Health Insurance Privacy and Portability Act that now closes specific patient information to the public.
She would only say that the man "was treated for symptoms not related to rabies or rabies exposure."
That same day, he sought treatment at CHRISTUS St. Michael Health Care Center's emergency room after leaving Wadley, complaining of nausea and vomiting, said Francine Francis, marketing communication manager for the Texarkana hospital.
The man was admitted to St. Michael's intensive care unit in the early morning hours of April 29 and died May 3, Ms. Francis said.
The donor never mentioned anything about animal bites or being exposed to rabies, she said.
Ms. Francis declined to answer questions about what initial diagnosis St. Michael's doctors made or the man's cause of death.
Ms. Francis said she did not know if the donor carried an organ donor card before he died or whether his family made the decision to donate his organs.
An autopsy was probably not performed, she said, because so much screening of the organs occurred prior to harvesting them.
Dr. Sutker said the medical staff at Baylor transplanted the organs on May 4 and considered the operations to be successful.
"They all went home after a normal amount of recovery time," he recalled.
The first suggestion that something had gone wrong came in late May. Two of the patients were readmitted to Baylor between May 25 and May 29, he said. One appeared to be suffering organ rejection, and the other appeared to have a medication-related problem.
"Infection was not suspected," he said. "Eventually, they began to develop neurologic problems, starting with confusion and headache, and eventually deteriorating from there."
The third recipient sought care May 30 at Longview's Good Shepherd Medical Center's emergency room, according to a news release issued by the hospital Thursday. The patient was treated for about 19 hours before the staff decided a transfer was needed back to Baylor.
"Sooner or later, all three of them ended up" in the intensive care unit, Dr. Sutker said. "We said, 'Something is going on here. All these patients received organs from the same donor.'"
The patients underwent a variety of tests trying to determine the underlying cause of their illness. But nothing was found, he said. Finally, they started dying.
The patient with the liver transplant died first on June 7, followed by the other two on June 8 and June 21. Because the cause of their deaths was unknown, the CDC was asked to investigate to determine whether there was a common infectious agent, Dr. Sutker said.
"We never expected rabies," he said. "It has never happened before, and it probably never will again."