Transmission of lymphocytic choriomeningitis virus by organ transplantation.
Transmission of lymphocytic choriomeningitis virus by organ transplantation.
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DOI：
10.1056/nejmoa053240
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发表时间：
2006-05-25
影响因子：
158.5
通讯作者：
Zaki, Sherif R.
中科院分区：
文献类型：
--
作者：
Fischer, Staci A.;Graham, Mary Beth;Zaki, Sherif R.
背景资料：2003年12月和2005年4月，两组实体器官移植受者出现了提示感染的体征和症状。每个集群进行了调查，因为诊断评价是unrevealing，并在每个共同的捐助者recognized.Methods：我们检查了临床标本从两个捐助者和八个收件人，使用病毒培养，电子显微镜，血清学检测，分子分析，免疫组化染色和组织病理学检查，以确定一个原因。流行病学调查，包括访谈，环境评估，和医疗记录审查，进行临床过程的特点，并确定病因的diseases.Results：实验室检测发现淋巴细胞性脉络丛脑膜炎病毒（LCMV）在所有的收件人，一个单一的，独特的菌株LCMV确定在每个集群。在这两项研究中，在器官供体中均未检出LCMV。在2005年的集群中，捐赠者在家中与一只感染LCMV毒株的宠物仓鼠有过接触，该毒株与器官接受者中检测到的毒株相同;在2003年的集群中没有发现LCMV感染源。移植受者在移植后三周内出现腹痛、精神状态改变、血小板减少、转氨酶水平升高、凝血功能障碍、移植物功能障碍以及发热或白细胞增多。腹泻、切口周围皮疹、肾衰竭和癫痫发作几乎不存在。8例受者中有7例在移植后9 ~ 76天死亡。一名接受病毒唑并降低免疫抑制治疗水平的受者幸存下来。结论：我们记录了通过器官移植传播的两组LCMV感染。
Background: In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were unrevealing, and in each a common donor was recognized.Methods: We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histopathological examination with immunohistochemical staining to identify a cause. Epidemiologic investigations, including interviews, environmental assessments, and medical-record reviews, were performed to characterize clinical courses and to determine the cause of the illnesses.Results: Laboratory testing revealed lymphocytic choriomeningitis virus (LCMV) in all the recipients, with a single, unique strain of LCMV identified in each cluster. In both investigations, LCMV could not be detected in the organ donor. In the 2005 cluster, the donor had had contact in her home with a pet hamster infected with an LCMV strain identical to that detected in the organ recipients; no source of LCMV infection was found in the 2003 cluster. The transplant recipients had abdominal pain, altered mental status, thrombocytopenia, elevated aminotransferase levels, coagulopathy, graft dysfunction, and either fever or leukocytosis within three weeks after transplantation. Diarrhea, peri-incisional rash, renal failure, and seizures were variably present. Seven of the eight recipients died, 9 to 76 days after transplantation. One recipient, who received ribavirin and reduced levels of immunosuppressive therapy, survived.Conclusions: We document two clusters of LCMV infection transmitted through organ transplantation.