Before his heart, liver and kidneys were removed and sent to transplant recipients across the country, the organ donor had a history of trapping raccoons to use as live bait for training dogs and was twice bitten by the creatures, officials say.
When he was admitted to a hospital with symptoms of rabies -- an inability to swallow liquids, seizures, tingling limbs and an altered mental state -- doctors believed he was suffering from food poisoning.
Yet it wasn't until a year and a half later that epidemiologists with the Centers for Disease Control and Prevention determined that the organ donor had been infected with a very rare case of raccoon rabies.
By that time, a kidney recipient in Maryland had also died of the disease.
In a study and accompanying editorial published Tuesday in JAMA, doctors called for new safeguards against the use of infected transplant organs and for the improved screening of potential donors.
Since 2002, there have been 11 other reported instances of infectious encephalitis, or brain swelling, being spread through organ transplants. Two of those involved rabies.
In the case of the most recent rabies death, the donor's family was asked about exposure to rabies before the organs were harvested, and they answered that there wasn't any.
However, study authors said that a standardized survey questionnaire might have elicited better information about the possible risk of rabies.
Lead author and CDC investigator Dr. Neil Vora, and colleagues, wrote too that doctors should now consider rabies as a possible risk if an organ donor is suffering from symptoms of infectious encephalitis. At the same time, doctors should standardize the definition of infectious encephalitis and outline appropriate laboratory tests.
"Currently, the rarity of rabies and time required to transfer samples and perform adequate laboratory diagnostics for rabies makes universal screening of all organ donors impractical," authors wrote.
"Although recognition of rabies is challenging and solid organ transplant transmission of infectious encephalitis is rare, further education to increase awareness is needed."
Globally, about 55,000 people a year die from rabies, mostly from dog bites. In the United States however, rabies deaths are extremely rare, with about two reported each year. Also, most domestic cases of the disease are transmitted by bats.
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