Donor in rabies cases was Air Force recruit

Encephalitis was not recognized as caused by virus

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A 20-year-old Air Force recruit who died of raccoon rabies had symptoms of the disease but wasn't tested before his organs were transplanted to four patients, one of whom died of rabies nearly 18 months later, federal health officials said Friday.

The three other organ recipients are getting rabies shots and haven't displayed symptoms. Doctors at the Centers for Disease Control and Prevention declined to speculate on their chances for survival.

Dr. Matthew Kuehnert, director of the agency's Office of Blood, Organ, and Other Tissue Safety, said investigators don't know why doctors in Florida didn't test the donor for rabies before offering his kidneys, heart and liver to people in Florida, Georgia, Illinois and Maryland.

The man in Maryland who received the transplant died. The Defense Department said he was an Army veteran who had transplant surgery at Walter Reed National Military Medical Center.

A rabies test after a death can take four hours once the tissue reaches a lab in Atlanta, New York and California, Franka said. That's precious time, considering a donated kidney remains viable for less than 24 hours; other organs last for less than six.

The donor had seizures and encephalitis — a brain inflammation that can be caused by rabies — but those symptoms can also be caused by a variety of bacterial, viral and other more common conditions.

"Rabies is very unusual and it can look like a lot of different things," Kuehnert said. "I personally can't say I would have been able to make the correct diagnosis had I been there."

Federal rules require organ banks to disclose "any known or suspected" infectious conditions that might be transmitted by the donor organs. "We don't know exactly what was communicated, but from what I understand of the patient workup, they did not find any evidence of an infection," Kuehnert said.

The donor died in September 2011 at a Florida medical facility. His cause of death was listed as encephalitis of unknown origin, Florida Department of Health epidemiologist Dr. Carina Blackmore said.

Public and military health officials said they're trying to identify people in all five states who had close contact with the donor or the recipients. Those people might also need treatment.

The CDC said there has been just one other reported instance of rabies transmission by transplanted solid organs, a 2004 case in which all four recipients died. There have been at least eight instances of rabies transmission through cornea transplant, said CDC spokeswoman Barbara Reynolds.

In the United States, rabies is diagnosed as the cause of just one to three human deaths per year, she said, and only one other person is reported to have died from a raccoon-type rabies virus.