1. Transfusion-Transmitted Cache Valley Virus Infection in a Kidney Transplant Recipient With Meningoencephalitis.
- Author
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Al-Heeti O, Wu EL, Ison MG, Saluja RK, Ramsey G, Matkovic E, Ha K, Hall S, Banach B, Wilson MR, Miller S, Chiu CY, McCabe M, Bari C, Zimler RA, Babiker H, Freeman D, Popovitch J, Annambhotla P, Lehman JA, Fitzpatrick K, Velez JO, Davis EH, Hughes HR, Panella A, Brault A, Staples JE, Gould CV, and Tanna S
- Subjects
- Humans, Antibodies, Neutralizing, Blood Transfusion, Bunyamwera virus, Kidney Transplantation adverse effects, Meningoencephalitis diagnosis
- Abstract
Background: Cache Valley virus (CVV) is a mosquito-borne virus that is a rare cause of disease in humans. In the fall of 2020, a patient developed encephalitis 6 weeks following kidney transplantation and receipt of multiple blood transfusions., Methods: After ruling out more common etiologies, metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) was performed. We reviewed the medical histories of the index kidney recipient, organ donor, and recipients of other organs from the same donor and conducted a blood traceback investigation to evaluate blood transfusion as a possible source of infection in the kidney recipient. We tested patient specimens using reverse-transcription polymerase chain reaction (RT-PCR), the plaque reduction neutralization test, cell culture, and whole-genome sequencing., Results: CVV was detected in CSF from the index patient by mNGS, and this result was confirmed by RT-PCR, viral culture, and additional whole-genome sequencing. The organ donor and other organ recipients had no evidence of infection with CVV by molecular or serologic testing. Neutralizing antibodies against CVV were detected in serum from a donor of red blood cells received by the index patient immediately prior to transplant. CVV neutralizing antibodies were also detected in serum from a patient who received the co-component plasma from the same blood donation., Conclusions: Our investigation demonstrates probable CVV transmission through blood transfusion. Clinicians should consider arboviral infections in unexplained meningoencephalitis after blood transfusion or organ transplantation. The use of mNGS might facilitate detection of rare, unexpected infections, particularly in immunocompromised patients., Competing Interests: Potential conflicts of interest. M. G. I. reports research support, paid to Northwestern University, from AiCuris, GSK (RSV Vaccine), Janssen, and Shire and Plumocide (antifungal); is a paid consultant for Adagio, ADMA Biologics, Takeda, AlloVir, Celltrion, Cidara, Genentech, Roche, Janssen, Shionogi, and Viracor Eurofins; is a paid member of data and safety monitoring boards for Adamis, AlloVir, CSL Behring, Janssen, Merck, SAB Biotherapeutics, Sequiris, Takeda, Talaris, and Vitaeris; and reports royalties paid to the author from UpToDate. C. Y. C. and S. M. have a patent on algorithms related to SURPI+ software, Pathogen Detection using Next-Generation Sequencing (PCT/US2016/052912). M. R. W. reports an unrelated research grant from Roche/Genentech; speaking honoraria from Takeda, Novartis, Genentech, and WebMD; payment for expert testimony from the Department of Justice; 1 patent, Method for High Percentage Recovery of Rare Cells (US-2020-0025783-A1), and 1 pending patent, Autoantibodies as a Biomarker of Paraneoplastic Encephalitis Associated with Testicular Cancer; and stock or stock options from VeriPhi Health. G. R. reports a leadership or fiduciary role as the chair of the College of American Pathologists Transfusion, Apheresis, and Cellular Therapy Committee. H. M. B. reports consulting fees from Idera (Novocure research), Myovant (Corea Therapeutics), and CARIS; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Guardant360; and support for attending meetings and/or travel from CARIS. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
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