Department of Ophthalmology, Clinical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
Cornea. 2011 Feb;30(2):241-4. doi: 10.1097/ICO.0b013e3181e4572a.
To examine the tissue samples of 2 corneal recipients from a rabies-infected donor for the presence of rabies to explain their survival.
Interventional case series with a review of the literature. The explanted corneal donor buttons were examined via nested reverse transcriptase polymerase chain reaction. The patients were followed up ophthalmologically and neurologically. Antirabies antibodies were measured in blood samples, and skin biopsies were examined by direct fluorescent antibody staining.
Two patients received corneas from the same multiorgan donor. Six weeks after transplantation, 3 of the donor's organ recipients became symptomatic and rabies virus was confirmed in tissue from the donor's central nervous system. Immediately, both the corneal recipients underwent active and passive postexposure treatment. The corneal buttons were replaced. Examination of the explanted donor corneas, skin biopsies, and serum and saliva samples showed no signs of rabies infection. The 2 corneal recipients were followed up at our hospital and, to date, are without symptoms of infection.
Transmission of the potentially deadly rabies virus by corneal transplantation has been described previously. To our knowledge, this is the first report in which no rabies virus transmission occurred without immediate postexposure treatment.
检查 2 例来自狂犬病感染供体的角膜受者的组织样本，以解释其存活原因。
回顾性病例系列研究，并对文献进行综述。通过巢式逆转录聚合酶链反应检查移植的角膜供体按钮。对患者进行眼科和神经学随访。测量血液样本中的抗狂犬病抗体，并通过直接荧光抗体染色检查皮肤活检。
2 名患者均接受了同一位多器官供体的角膜。移植后 6 周，3 名供体器官受者出现症状，从供体中枢神经系统中证实存在狂犬病病毒。立即对 2 名角膜受者进行了主动和被动暴露后治疗。更换了供体角膜移植片。对供体角膜、皮肤活检、血清和唾液样本的检查均未发现狂犬病感染的迹象。2 名角膜受者在我院接受了随访，迄今为止，均无感染症状。
以前曾有报道称通过角膜移植传播致命的狂犬病病毒。据我们所知，这是首例未立即进行暴露后治疗而未发生狂犬病病毒传播的报告。
