Rabies: new insights into pathogenesis and treatment.

PURPOSE OF REVIEW

The occurrences of transmission of rabies virus by organ and vascular conduit transplantation, and recovery from rabies by a patient in Wisconsin, will be addressed. Perspectives will be given on the prevention of rabies by organ transplantation and on the management of patients with rabies.

RECENT FINDINGS

In 2004 transplantation of organs and a vascular conduit was responsible for the transmission of rabies virus, resulting in seven fatal cases of rabies in the USA and Germany. Likely infectious rabies virus was present within nerves of the transplanted organs and arterial segment and productive infection developed in the immunosuppressed recipients. In 2004 a young patient, who did not receive postexposure rabies prophylaxis after a bat bite, survived rabies in Wisconsin. The importance of therapy she received on her favorable outcome remains unknown.

SUMMARY

Recent transmissions of rabies virus from organ-transplantation donors highlight the importance of clinical recognition of rabies. Laboratory screening of potential donors for rabies prior to organ transplantation would be associated with logistical problems and serious consequences due to false-positive results. The survival of a patient with rabies has offered hope that effective therapy of rabies may become a reality in the future.