Table.
Laboratory Findings of Recipients of Solid Organs From a Donor With Rabies in September 2011
| Patient | Specimen | Date of Collection | Rabies Virus-Specific Binding IgG and IgM Antibodies (IFA)a | Rabies Virus Neutralizing Antibodies (RFFIT)b | Rabies Virus Nucleic Acid (RT-PCR) | Rabies Virus Antigen (IHC) |
|---|---|---|---|---|---|---|
| Donor | Serum | 12/2010 | Not detected | Not detected | ||
| Serum | 5/2011 | Not detected | Not detected | |||
| Oral cavity biopsy | 7/2011 | Not detected | Not detected | |||
| Serum | 19 d ARSO | IgG ≥1:128, IgM ≥1:32 | 7.2 IU/mLc | |||
| Brain | Autopsy | Detected | Detected | |||
| Gastrointestinal tract | Autopsy | Detected | ||||
| Lungs, thyroid, spleen, pancreas | Autopsy | Not detected | ||||
| Deceased left kidney recipient | Transplanted kidney biopsy | 7 d ARSO | Not detected | |||
| Serum | 22 d ARSO | IgG ≥1:128, IgM 1:8 | 0.4 IU/mLc | |||
| CSF | 22 d ARSO | Not detected | Not detected | |||
| Saliva | 22 d ARSO | Detected | ||||
| Nuchal skin biopsy | 22 d ARSO | Detected | ||||
| Brain | Autopsy | Detected | Detected | |||
| Spinal cord | Autopsy | Detected | ||||
| Heart, lungs, thyroid, liver | Autopsy | Not detected | ||||
| Transplanted kidney | Autopsy | Not detected | Not detected | |||
| Native kidneys | Autopsy | Not detected | Not detected | |||
| Asymptomatic right kidney recipient | Thyroid, parathyroid, thymus, lymph nodes | 11/2011 | Not detected | |||
| Transplanted kidney biopsies | 12/2011, 9/2012 | Not detected | Not detected | |||
| Urine | 3/2013 | Not detected | ||||
| Serum, PEP day 0 | 3/2013 | Not detected | Not detected | |||
| Serum, PEP day 14 | 3/2013 | 0.4 IU/mLc | ||||
| Serum, PEP day 28 | 4/2013 | 0.3 IU/mLc | ||||
| Serum, PEP day 39 | 4/2013 | 0.3 IU/mLc | ||||
| Asymptomatic heart recipient | Transplanted heart biopsies | 9/2011–3/2013 | Not detected | Not detected | ||
| Serum, PEP day 0 | 3/2013 | Not detected | Not detected | |||
| Serum, PEP day 14 | 3/2013 | 0.4 IU/mLc | ||||
| Serum, PEP day 49 | 5/2013 | 0.3 IU/mLc | ||||
| Asymptomatic liver recipient | Serum, PEP day 0 | 3/2013 | Not detected | Not detected | ||
| Serum, PEP day 14 | 3/2013 | 0.5 IU/mLc | ||||
| Serum, PEP day 28 | 4/2013 | 2.2 IU/mLc | ||||
| Serum, PEP day 42 | 4/2013 | 40.8 IU/mLc |
Abbreviations: ARSO, after rabies symptom onset; CSF, cerebrospinal fluid; IFA, indirect fluorescent antibody test; IHC, immunohistochemical test; PEP, rabies postexposure prophylaxis; RFFIT, rapid fluorescent focus inhibition test; RT-PCR, reverse transcriptase–polymerase chain reaction.
Specimens were incrementally diluted (ranging from 1:1 through 1:128) to screen for rabies virus–specific binding IgG and IgM antibodies. If a positive reaction did not occur at the dilutions tested, the result is listed as “not detected.”
Specimens were incrementally diluted to determine end-point titers against a known rabies virus dose, with a 50% reduction of virus at a dilution of 1:5 considered the lower limit of detection. End-point titers were converted to IU/mL by comparison with a known dilution of US Standard Rabies Immune Globulin.
Complete rabies virus neutralization was demonstrated at a serum dilution of 1:5.