Correspondence

A New Arenavirus in Transplantation

N Engl J Med 2008; 358:2638-2639June 12, 2008

Article

To the Editor:

We find the description of a “new arenavirus” by Palacios and colleagues (March 6 issue)1 interesting, but we consider several of their conclusions to be unjustified or misleading. First, the characterized virus is simply lymphocytic choriomeningitis virus (LCMV), its nucleotide sequence lying well within the range of variability for the species as defined by the International Committee on Taxonomy of Viruses (ICTV) for this virus. Second, diagnostic tests for LCMV (polymerase chain reaction, serologic tests, or viral isolation) would undoubtedly have detected the agent, had these tests been used on initial screening. The omission of these tests from otherwise comprehensive testing was odd, given the clinical similarities to previously described clusters of post-transplantation LCMV infections.2 Although the study correctly shows how ultra-high-throughput sequencing is a powerful tool for microbiology, it appears that the current study is an example of its unnecessary use. Sequence diversity within a species is not the same thing as a “new virus.”

Tobias Allander, M.D., Ph.D.
Karolinska Institutet, SE-17177 Stockholm, Sweden
tobias.allander@karolinska.se

Xavier de Lamballerie, M.D., Ph.D.
Medical University of Marseille, 13005 Marseille, France

Peter Simmonds, Ph.D.
University of Edinburgh, Edinburgh EH9 1QH, United Kingdom

2 References

1. 1

   Palacios G, Druce J, Du L, et al. A new arenavirus in a cluster of fatal transplant-associated diseases. N Engl J Med 2008;358:991-998[Erratum, N Engl J Med 2008;358:1204.]
   Full Text | Web of Science | Medline

2. 2

   Fischer SA, Graham MB, Kuehnert MJ, et al. Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med 2006;354:2235-2249
   Full Text | Web of Science | Medline

Author/Editor Response

We reported the sequence and genetic relationship of this virus to other arenaviruses and described it as being LCMV-like; however, formal classification must rest with the ICTV. There is no pathognomonic presentation for transplant-associated LCMV. Whereas our patients had encephalopathy without seizures, the report on the earlier series described four patients: two with seizures, two with no neurologic disease, and all four with other findings, including diarrhea, abdominal pain, incision tenderness, and pulmonary infiltrates. We investigated an unexplained outbreak, simultaneously screened approximately 100,000 sequences, and pursued a candidate pathogen using culture and electron-microscopical, immunohistochemical, molecular, and serologic methods. We predict that this example will be followed by many others as high-throughput sequencing becomes more affordable and accessible to clinicians and public health agencies.

W. Ian Lipkin, M.D.
Mailman School of Public Health of Columbia University, New York, NY 10032
wil2001@columbia.edu

Mike Catton, M.D.
Victorian Infectious Diseases Reference Laboratory, North Melbourne, VIC 3053, Australia

Sherif R. Zaki, M.D., Ph.D.
Centers for Disease Control and Prevention, Atlanta, GA 30333

Citing Articles (1)

Citing Articles

1. 1

   Raymund R. Razonable. (2011) Rare, unusual, and less common virus infections after organ transplantation. Current Opinion in Organ Transplantation 16:6, 580-587
   CrossRef