3 organ recipients get dengue from infected donor; 2 die

Tribune News Service

Naina Mishra

Chandigarh, November 23

The doctors at the Post-Graduate Institute of Medical Education and Research (PGI) have documented a rare case of a liver transplant patient getting infected with dengue through the brain dead donor eight days after the procedure.

The dengue illness in the patient who had received liver from the deceased donor was severe that required mechanical ventilation and intensive care. The patient’s condition improved and was discharged.

Further, two other kidney transplant recipients had also tested positive for dengue during the same period, and they eventually died at the PGI. The donor was common in all three cases.

As multiple recipients had developed post-transplant dengue infections, the PGI doctors have strongly suspected the deceased donor common to all three recipients had subclinical infection on admission via mosquito bite prior to arrival at the hospital.

The incubation period of dengue virus ranges between four and 10 days, and most cases become symptomatic in two to four days. “Given the clinical timelines of symptom presentation in the liver and kidney transplant recipients, the possibility of dengue transmission from donor to recipient is highly plausible,” noted the case study.

Generally, the major route of transmission of dengue is vector transmission by Aedes aegypti mosquito. Dengue transmission through blood transfusion, vertical transfusion from mother to foetus, and organ transplant-related transmission are among possible routes of non-vector transmission, but such cases are rare.

According to PGI doctors, there are five previously reported cases worldwide of dengue transmission through liver transplant, and this is the sixth such case.

The brain-dead donor was asymptomatic for dengue infection, and the liver recipient developed fever and low platelet count eight days after transplant. The recipient’s test results were positive for dengue, however, donor’s samples were not available.

“The exposure to dengue infection of the deceased donor can only be attributed to the endemic nature of dengue fever during October and November in northern India, particularly Chandigarh, which was the location of clinic. It may be possible the donor was exposed to dengue virus during a period that predated the viremia (presence of virus in blood) phase,” said the case study.

The doctors concluded in dengue-endemic areas, tests for NS1 (non-structural protein of dengue virus) antigen during dengue outbreaks and annual periods of high transmission should be part of the donor evaluation protocol in solid-organ transplantation.

“The NS1 antigen test may allow detection of asymptomatic carriers and prevent late recipient infections and thereby reduce morbidity and associated mortality. This case highlights the importance of a high index of suspicion for dengue infection and importance of the dengue test that should be included on the standard evaluation of solid-organ transplant donors,” the study concluded.

Rare occurrence, say doctors

• Major route of transmission is through mosquito. Transmission via blood & vertical (mother to foetus) transfusions and organ transplant is possible, but rare
• There are only five known cases of dengue transmission through liver transplant worldwide. This is the sixth such case, say PGI doctors
• Brain-dead donor was asymptomatic for dengue infection. The liver recipient developed fever eight days after transplant, survived
• Doctors suspect deceased donor, common to all 3, had subclinical infection prior to arrival at hospital

Need to run test on donors

This case highlights importance of including dengue test on the standard evaluation of solid-organ transplant donors. — PGI study

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