In January 2016, two patients died of
rabies after receiving kidney transplants from a common organ donor at a hospital in Changsha, Hunan, China. The medical records, epidemiological data of the organ donor, two kidney and a liver recipients were reviewed. Intravitam saliva samples of the two kidney recipients were tested for rabies virus (RABV) using real-time RT-PCR, and the
nucleoprotein (N) gene was amplified and sequenced by Sanger sequencing. Whole genome sequences were analyzed using next-generation sequencing. The N genes of the two kidney recipients showed 100%
nucleic acid identity. Phylogenetic analysis of the complete genome, N and
glycoprotein (G) genes indicated that the RABV was homologous with dog isolates from the Hunan province and belong to the China I lineage, which is widespread in China. The organ donor was a 22-month-old boy who died from unknown acute progressive
encephalitis. After undergoing sub-
hypothermia hibernation
therapy,
rabies-associated symptoms were atypical, and
rabies was neglected because serum RABV-specific
antibodies were negative. An unknown
wound on the forehead of the donor was found 2 months before the onset of symptoms. Based on the clinical, epidemiological, and molecular findings, we speculated that the RABV initially originated in the donor from a dog
bite, and was then transmitted to the recipients by
organ transplantation. An uncertain exposure history and misdiagnosis played important roles in the spread of the RABV.
Rabies should be considered in patients with acute progressive
encephalitis of unexplained etiology, especially in potential organ donors.