Rabies has been described as an unpredictable disease whose only consistent feature is its uncharacteristic symptoms, according to background information in the article. Although rabies cases in the United States are rare, the incidence of rabies may be underreported because of the absence of a known animal exposure, lack of clinical suspicion, difficulty in making a diagnosis before death and the decreasing frequency of autopsies. There have been eight documented cases of rabies transmission through corneal transplants, including one in the U.S., but there have been no previously reported cases of rabies transmission through solid organ transplant.
Elizabeth C. Burton, M.D., of Baylor University Medical Center, Dallas, and colleagues, describe detailed features of four cases of transplant recipients who received organs or vascular tissue from a common donor who developed a rapid neurological deterioration and died with clinically unsuspected rabies infection. The two kidneys, the liver and blood vessel tissue were successfully transplanted into four recipients. All four transplant recipients also developed rapidly progressive neurological disease and died within 48 days following transplant.
"Although antemortem [before death] diagnosis of rabies is possible the possibility of rabies is often not considered, particularly in the absence of a known exposure," the authors write. "In the cases discussed here, a definitive diagnosis of rabies was not made until after death, similar to previous reports in which more than one third of
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