Michigan man dies from rabies-infected kidney transplant, CDC says

FOX 2 - A Michigan man died from a kidney transplant due to a believed rabies virus infection last year.

Timeline:

The strange deaths of the human-to-human rabies transmission was reported by the Centers for Disease Control, which became aware of the cases January 27, 2025.

This was the fourth transplant-transmitted rabies event in the United States since 1978, according to the CDC. Early public health consultation might help prevent donation of rabies-infected organs and tissue. PEP assessment should be considered when potential rabies exposures are identified in donors.

From 1978 to 2013, three transplant-transmitted rabies events in the United States affected nine tissue or organ recipients. Rabies is almost always fatal without timely receipt of postexposure prophylaxis

In 2024 a Michigan resident received a left kidney transplant from an Idaho donor at an Ohio hospital.

He died seven days later with the rabies virus RNA was detected in saliva, nuchal skin, and brain tissue samples.

The Rabies virus immunoglobulin (Ig) M, IgG, and neutralizing antibodies were detected in serum, the CDC said.  

The Idaho donor:

When the donor was investigated, it was revealed he was injured by a skunk he was defending a kitten from, in October of 2024.

Two days after he showed rabies symptoms in December, he was found unresponsive at home after presumed cardiac arrest.

He was resuscitated and hospitalized but never regained consciousness. He was declared brain dead and removed from life support on hospital day 5. Left kidney, heart, lungs, and both corneas were recovered.

After rabies was suspected in the kidney recipient, stored serum collected from the donor was thought to be negative for rabies virus antibody after testing.

But in a multi-week laboratory investigation of the right and left kidney biopsy samples, the CDC detected rabies virus RNA consistent with a silver-haired bat rabies virus variant in a biopsy sample of the right kidney.

This suggests the skunk had previously come into contact with a bat.

This result is believed to be organ-derived transmission. The left kidney biopsy sample had insufficient tissue for testing.

The backstory:

The Michigan man - whose identity has not been released, began to feel side effects from the kidney donation five weeks later with tremors, lower extremity weakness, confusion, and urinary incontinence.

Seven days after symptom onset, he was hospitalized with fever, hydrophobia, dysphagia, and autonomic instability. On hospital day 2, he required invasive mechanical ventilation.

On hospital day four, clinicians consulted the Ohio Department of Health and CDC because the recipient’s signs and symptoms were compatible with rabies.

After he died on day seven, viral characterization was consistent with the silver-haired bat (Lasionycteris noctivagans) rabies virus variant. Michigan public health officials interviewed the kidney recipient’s family; no animal exposures were reported.

Interviews with the family added details not included in the ogan donation questionnaire.

The skunk interaction happened as the donor held a kitten on his rural property. The encounter that rendered the skunk unconscious, the donor sustained a shin scratch that bled, but he did not think he had been bitten.

A member of the donor’s household said that five weeks later, in early December, the donor was confused, had difficulty swallowing and walking, experienced hallucinations, and had a stiff neck.

Two days later he suffered the cardiac arrest incident.

After the CDC confirmed diagnosis, jurisdictional health departments and CDC conducted an investigation to determine the source of the infection and to identify other persons at risk.

The other organ donations:

Four ocular grafts were prepared from recovered corneas. Three patients, one each from California, Idaho, and New Mexico, received grafts in December 2024 and January 2025. 

While investigation of the donor’s rabies status was ongoing, the cornea recipients underwent precautionary graft removal and received PEP. They remained asymptomatic. 

A planned transplantation of the fourth corneal graft to a Missouri patient was cancelled. CDC detected rabies virus RNA consistent with a silver-haired bat rabies virus variant in one previously implanted corneal graft.

The heart and lungs of the donor were not transplanted but were used in training procedures at a Maryland medical research facility. By the time of the public health investigation, no specimens were available for testing.