New Lymphocytic Choriomeningitis Virus-Like Arenavirus Infections

This chapter describes cases of lymphocytic choriomeningitis virus (LCMV) and LCMV-like infections in three clusters of solid organ transplant recipients. It discusses some of the implications for organ transplant units. Infections in humans can occur through exposure to rodent urine, although nosocomial or laboratory spread has been documented. LCMV is known to occur primarily in Europe and the Americas but has been isolated from mice in other areas such as Japan and China. In Wisconsin in 2003 and in Rhode Island in 2005, there were two clusters of transplant-associated infections caused by LCMV. Arenavirus-like virus particles were seen using electron microscopy, and indirect fluorescent antibody testing (IFAT) confirmed LCMV as the cause. The clinical and diagnostic features of the three clusters of cases have implications for donor selection and organ transplantation services. Reverse transcription polymerase chain reaction (RT-PCR) testing is unlikely to be useful, as the three donors all tested negative using this technique. Although transplant-related infections with arenaviruses are rare, the consequences seen in the clusters are devastating. Exclusion of donors who have spent any time in areas where LCMV or LCMV-like viruses are endemic is likely to prove problematic. This is likely to exclude donors who are not infected in times where there is a shortage of human donors.