The transplants were done in Massachusetts and Rhode Island hospitals April 10 and 11; the patients died a few weeks later.

01:00 AM EDT on Monday, May 23, 2005

BY FELICE J. FREYER
Journal Medical Writer

In a rare case of disease transmission through organ donation, a common, rodent-borne virus appears to have caused the deaths of three people who received transplants last month from a Rhode Island donor.

Rhode Island health officials yesterday disclosed that lymphocytic choriomeningitis virus, or LCMV, had been identified in four organ recipients, one of whom survived. They said the donor probably became infected by a pet hamster purchased about three weeks before the donor died of an unrelated cause, a stroke.

The virus is found in about 5 percent of mice and occasionally in pet rodents. When transmitted to humans through contact with an infected animal's feces, urine or saliva, it typically causes mild flu-like symptoms or none at all. The death rate from LCMV is below 1 percent. But transplant recipients are made vulnerable by drugs that suppress their immune systems to prevent rejection of the organ.

There has been only one other recorded instance -- in Wisconsin in December 2003 -- in which LCMV was transmitted via organ donation, according to the U.S. Centers for Disease Control and Prevention.

The donor, who died at Rhode Island Hospital, gave both kidneys, a set of lungs, the liver and corneas, according to the New England Organ Bank. Four people received the organs on April 10 and 11, two at Massachusetts hospitals and two at Rhode Island Hospital, which transplants kidneys. Three died within three weeks of the transplants; one of the kidney recipients survived. The two cornea recipients did not have any symptoms of infection.

Transplanted organs are not tested for LCMV because no test is available to hospitals and the virus cannot be detected within the time frame that organs are viable, according to the New England Organ Bank.

"Everyone did everything appropriately in screening the person [who donated]," said Dr. David R. Gifford, Rhode Island health director. "It's an unfortunate, sad event."

In a news conference at the Health Department yesterday, Gifford took the occasion to advise pregnant women in the first and second trimesters to stay away from rodent urine and feces, such as from house mice or pet rodents, because LCMV has been linked to miscarriage and neurological illness in newborns.

But otherwise, Gifford said, he has no other public health message to draw from the incident. There is no evidence that the virus is becoming more prevalent or dangerous, he said.

The donor's infected hamster was purchased at PetSmart in Warwick, which has removed its entire rodent population for testing, Gifford said. An investigation is continuing in cooperation with the state Department of Environmental Management.

Dr. Staci A. Fischer, the infectious disease specialist on the Rhode Island Hospital transplant team, said the infections came to light when she saw two kidney-transplant patients with similar and puzzling symptoms -- diarrhea, fever and inflammation of the liver, symptoms that she said don't often occur simultaneously.

"It's too unusual that they both have the same symptoms. They don't live in the same area," Fischer said.

When she noticed that both patients had been transplanted on the same day, Fischer said, she checked to see whether the same donor had provided organs. Then she contacted the Boston hospitals (Massachusetts General Hospital and Brigham & Women's Hospital) where the donor's lungs and liver had been transplanted. She learned that the lung patient had already died and the liver recipient "was at death's door."

The CDC, the health departments of both states, the transplant centers and the New England Organ Bank then launched an investigation. Although the CDC identified the virus in the recipients, it still has not been detected in the donor's blood and tissues despite days of testing in the CDC lab. But a pet hamster at the donor's home tested positive for LCMV.

Fischer said the donor happened to die just as the virus was making its way through her tissues; a week or so later the virus probably would have been gone. Transplant patients are most susceptible to infection in the first days after the operation, when they receive the highest doses of immune-suppressing drugs. "It's really the ultimate in the worst bad timing," she said.

Fischer said it's "amazing" that one of the kidney recipients survived.

The incident was particularly distressing for the transplant team, she said, because the two kidney patients -- whom she described as "not old" -- were not in immediate danger of dying. Both could have lived for some time on dialysis.

But when asked whether anything could have been done differently, Fischer said, "Absolutely not. I would have taken her liver and kidneys myself. . . . There was no evidence that she had this infection." (Fischer said she wasn't sure that the donor was a woman.)

Last year, three people died after being transplanted at a Texas hospital with organs infected with rabies, the first recorded case of rabies transmission through solid organ donation. In 2002, donated organs in Georgia infected four people with West Nile virus; one died.

Sean Fitzpatrick, spokesman for the New England Organ Bank, said that organ donors are tested for syphilis and five viruses, including HIV and hepatitis B and C. Other tests are either not commercially available or don't yield results quickly enough, he said.

"There are thousands of different types of infectious organisms that are in people's bodies at any given time," Fitzpatrick said. "That's part of the risk-benefit ratios that transplant surgeons use when they make a decision to advise a patient to get a transplant or not."

The primary source of LCMV is the common house mouse; about 5 percent of mice carry it. Other types of rodents, such as pet hamsters, can become infected. People can get it from contact with an infected rodents' saliva, urine or feces, but don't transmit to other people, except for a pregnant mother to her fetus and organ transplants. About 2 percent to 5 percent of people, when tested, show evidence of infection, but most never had any symptoms.

The few who do show symptoms get sick with fever, stiff neck, malaise, loss of appetite, muscle aches, headaches, nausea and vomiting, starting 8 to 13 days after exposure.

People should wear gloves while cleaning a pet rodent's cage, wash their hands after playing with the rodent and avoid kissing it, health officials advised.

People with health-related questions may call the Family Health Information Line at (800) 942-7434. For animal-related questions, call the state Division of Agriculture at 222-2781.