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 six 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 by reverse transcription-polymerase chain reaction (RT-PCR), plaque reduction neutralization test (PRNT), 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. Conclusion 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 testing might facilitate detection of rare, unexpected infections, particularly in immunocompromised patients.

中文翻译：

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肾移植受者脑膜脑炎的输血传播卡什谷病毒感染


背景 Cache Valley 病毒 (CVV) 是一种由蚊子传播的病毒，是人类罕见疾病的原因。 2020 年秋季，一名患者在肾移植并接受多次输血后六周出现脑炎。方法 在排除更常见的病因后，对脑脊液（CSF）进行宏基因组下一代测序（mNGS）。我们回顾了指标肾接受者、器官捐献者以及同一捐献者其他器官接受者的病史，并进行了血液回溯调查，以评估输血是否是肾接受者可能的感染源。我们通过逆转录聚合酶链反应（RT-PCR）、噬菌斑减少中和试验（PRNT）、细胞培养和全基因组测序对患者样本进行了检测。结果 通过 mNGS 在指标患者的脑脊液中检测到 CVV，并通过 RT-PCR、病毒培养和额外的全基因组测序证实了这一结果。通过分子或血清学检测，器官捐献者和其他器官接受者没有感染 CVV 的证据。在指示患者在移植前立即接受的红细胞供体的血清中检测到了针对 CVV 的中和抗体。在接受同一次献血的辅助成分血浆的患者的血清中也检测到了 CVV 中和抗体。结论 我们的调查表明 CVV 可能通过输血传播。对于输血或器官移植后不明原因的脑膜脑炎，临床医生应考虑虫媒病毒感染。使用 mNGS 检测可能有助于检测罕见的、意外的感染，特别是在免疫功能低下的患者中。