The incubation period for rabies is typically between one and three months, according to the World Health Organization, but symptoms can take more than a year to appear.
That the kidney recipient lived for 17 months after exposure to the virus makes his incubation period "the longest documented in transplant recipient who had not received prior rabies," according to the report. That's surprising, given the cocktail of immunosuppressant drugs he was taking after the transplant.
Rabies isn't the only nervous system infection that has been transmitted through solid-organ transplants. Since 2002, there have been 11 reported cases of transmission of infectious encephalitis linked to the West Nile virus, lymphocytic choriomeningitis virus and Balamuthia mandrillaris, according to the report.
"Infectious encephalitis can have nonspecific clinical features easily mistaken for other disease conditions," the authors wrote.
"Currently, the rarity of rabies and time required to transfer samples and perform adequate laboratory diagnostics for rabies makes universal screening of all organ donors impractical," they added.
"However, given the lethality of transplant-associated encephalitis, implementation of a standardized approach for recognizing infectious encephalitis among organ donors is warranted."