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A unique case of raccoon rabies is the cause of death after a US kidney donor died in 2011 and his transplant recipient 18 months later, US researchers said Tuesday.

In March, health officials announced that a Maryland man had died of rabies contracted through exposure to an infected kidney he had received 18 months before he fell ill.

The report in the July 24 edition of the Journal of the American Medical Association describes the final results of an investigation into the case, which was announced by US health authorities in March.

The reason his organs were passed on as suitable donor organs is due to the fact that the patient took so long to develop the symptoms associated with rabies.  It was only after ruling out other possibilities and retesting tissue samples saved from the autopsy of the donor that investigators discovered the source of the infection.

They quickly notified three other people who had received organs from the same donor. Those patients have all received protective rabies shots and are doing well, officials said.

Organ donors are regularly checked for a range of infectious diseases, including HIV, herpes, hepatitis and cytomegalovirus. They are not routinely screened for rabies. That's partly because the disease is very rare - an average of two rabies deaths are reported in the United States each year - and partly because rabies testing can take weeks to return results. Human organs have to be transplanted very quickly, typically within hours of a donor's death.

"There have only been three ever-reported clusters of transplant transmitted rabies worldwide, two in the United States and one in Germany, through solid organ transplantation," said Dr. Sridhar Basavaraju, who was part of the team that investigated the deaths.

Basavaraju is an epidemiologist with the Office of Blood, Organ, and Other Tissue Safety at the U.S. Centers for Disease Control and Prevention.