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Volume 20, Number 9—September 2014
Synopsis

Encephalitis Caused by Pathogens Transmitted through Organ Transplants, United States, 2002–2013

Sridhar V. BasavarajuComments to Author , Matthew J. Kuehnert, Sherif Zaki, and James Sejvar
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

Table

Infectious agents associated with encephalitis reported among clusters of solid organ transplant recipients in the United States, 2002–2013*

Infectious agent Classification Natural transmission route No. reported clusters Clinical features of infection Laboratory detection method Treatment
WNV Enveloped, positive, single-stranded RNA virus; Flavivirus family Bites from infected mosquitoes (Culex spp.) 6 Febrile illness, meningitis, encephalitis, poliomyelitis-like limb paralysis Detection of WNV-specific antibodies or WNV nucleic acid in serum or CSF samples None; several experimental therapies under investigation
Rabies virus Enveloped, negative, single-stranded RNA virus; Rhabdoviridae family, Lyssavirus genus Exposure to secretions, typically saliva, of infected animals (in North America, most commonly bats, raccoons, and skunks) 2 Nonspecific prodrome followed by confusion, paresthesias, insomnia, agitation, paresis, spasm of swallowing muscles, coma, and death Before death:
 PCR or virus isolation in saliva, PCR and fluorescent antibody testing of nuchal biopsy samples, antibody testing of serum, and PCR or antibody testing of CSF;
after death:
fluorescent antibody staining of brain tissue or frozen tissue from nuchal biopsy, and serologic diagnosis by neutralization tests in mice or cell culture Supportive; treatment with induced coma and antiviral therapy, as reported (36); 
postexposure prophylaxis for asymptomatic recipients of organs from infected donors
LCMV Enveloped, RNA virus; Arenaviridae family Exposure to infected rodents, presumably to urine 3 Febrile illness in most symptomatic persons; aseptic meningitis, encephalitis Cell culture, electron microscopy, immunohistochemistry, detection of LCMV antibodies, PCR or high-throughput sequencing Supportive
Balamuthia mandrillaris Free-living aerobic amebae Ubiquitous in soil 2 Skin lesions; single or multiple space-occupying intracranial lesions; granulomatous amebic encephalitis characterized by hemiparesis, aphasia, seizures Culture or identification of amebic trophozoites or cysts in biopsy sample of affected tissue; real-time PCR of CSF Multidrug combinations, which may include pentamidine isethionate, 5-flucytosine,
fluconazole, clarithromycin or azithromycin, sulfadiazine,
miltefosine, thioridazine, or liposomal amphotericin B†

*CSF, cerebrospinal fluid; LCMV, lymphocytic choriomeningitis virus; WNV, West Nile virus.
http://www.cdc.gov/parasites/balamuthia/treatment.html.

Main Article

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Page created: August 13, 2014
Page updated: August 13, 2014
Page reviewed: August 13, 2014
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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