Yes, I know it was from the donor, but I’m interested in possible scenarios about how this could happen
Is it possible the donor was a ‘carrier’ (had the virus but no symptoms), or is it necessarily that the donor contracted the disease just before they died? Was the donor death connected at all to rabid animal contact? I see the story alludes to this happening before…which seems very much against the odds.
Most likely, the person was harboring the rabies virus but died from something else in the meantime, and since the recipient was immune-suppressed, this allowed the virus to fluorish in ways it couldn’t have in an otherwise healthy person.
Seems prudent they would check this ahead of time.
Anyone needing an organ is compromised.
so it does happen that a person could harbor the virus without showing symptoms?..I mean long term…not like they harbored the virus for two days before dying.
Depending on multiple factors, one of them being the distance from the bite to the central nervous system, it can be MONTHS before a person develops symptoms.
Screening for rabies in the general population would return more false positives than true positives, frankly. It’s such a rare, random thing for it to turn up in a donor that I don’t think any place does such screens on average risk folks. Now if they worked with rabid dogs or lots ofbats, then it might make sense to do a screen if they were donating their organs.
The donor was probably exposed to rabies but not yet symptomatic; symptom onset in humans is several weeks up to several months, and it can be conveyed by a small bite, scratch, or just ingesting contaminated saliva or it coming into contact with eyes or nose via fomite route of transmission. Rabies is generally 100% fatal to humans (there are indications that some isolated populations may have the ability to express virus-neutralizing antibodies) and there is no way to treat it after symptom onset except palliative care.
Many wild mammal species can be asymptomatic and transmit the disease including raccoons, skunks, bats, feral/outside domestic cats, and canids of all kinds. A donor who kept an unprotected pet or wild animal could have been exposed, and prior to expressing symptoms the virus resides in the nervous system so blood tests will not find it. Typically the only way to assuredly identify a rabies infection during a dormant period is autopsy inspection of brain and spinal tissue.
Stranger
This happened in an episode of Scrubs.
Yes, this. Rabies travels slowly up the nerves to the brain, with no obvious symptoms until it reaches the target. Something that can take as long as 50 days. If one of those nerves passed through the organ being transplanted, there’s the explanation as to how it happened.
The rabies virus is transmitted in the saliva of an infected animal. From the point of entry (usually a bite), the virus travels along nerves to the spinal cord and then to the brain, where it multiplies. From there, it travels along other nerves to the salivary glands and into the saliva. Once the rabies virus reaches the spinal cord and brain, rabies is almost always fatal. However, the virus typically takes at least 10 days—usually 30 to 50 days—to reach the brain (how long depends on the bite’s location). During that interval, measures can be taken to stop the virus and help prevent death. Rarely, rabies develops months or years after an animal bite.
Something to note: not all human rabies cases present as the classic “furious” form with agitation, seizures, hydrophobia etc. There’s a paralytic form in 20% or so of cases which may be misdiagnosed, especially if there’s no history of animal bite. In this example, the differential diagnosis included Guillain-Barre syndrome, and the suspect bite was two years previously.*
*there’s a case on record of a six-year incubation period. Long incubation before rabies symptoms appear generally means an inoculation far from the brain/major nerves and/or a small amount of viral inoculum.