Emerging infectious diseases that threaten the blood supply. * Alter HJ, Stramer SL, Dodd RY.
Infectious Diseases Section and Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD.
Following the devastating effects of blood-transmitted human immunodeficiency virus (HIV), blood establishments have become increasingly vigilant for the emergence or re-emergence of new threats to the safety of the blood supply. Many agents have fulfilled the broad definition of emerging blood-transmitted infections, including West Nile virus (WNV), Trypanosoma cruzi, Plasmodium spp., Babesia spp., parvovirus B19, dengue virus, and the prions that cause variant Creutzfeld-Jacob disease (vCJD).
Other agents such as human herpes virus- 8 (HHV-8-Kaposi's sarcoma virus) and Borellia (Lyme disease) and, perhaps, avian flu virus, are known to have a viremic phase, but have not yet been proved to be transfusion-transmitted.
In the wake of these threats, transfusion services use a variety of donor screening interventions, including serologic assays, nucleic acid assays, and geographic exclusions based on potential exposure. The ultimate safeguard may be a pre-emptive pathogen inactivation strategy that will disrupt all nucleic acid-containing agents (though not prions).
Considerable effort and resources have been invested in this arena, but currently no single technique is effective for inactivation of both liquid and cellular blood products and toxicity issues have not been completely resolved. The blood supply is remarkably safe with the risk of major pathogens such as hepatitis C virus (HCV) and HIV now reduced to less than one transmission per 2 to 3 million exposures.
However, to approach near-zero infectious disease risk for emerging and re-emerging pathogens, new strategies such as pathogen inactivation or multi-pathogen microarray technology will need to be developed or refined.
PMID: 17198845 [PubMed - in process]
Posted by imanurse (Member # 7022) on :
J Parasitol. 2006 Aug;92(4):869-70. Links
Transfer of Borrelia burgdorferi s.s. infection via blood transfusion in a murine model.
* Gabitzsch ES, Piesman J, Dolan MC, Sykes CM, Zeidner NS.
Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases, Bacterial Zoonoses Branch, Foothills Campus, Fort Collins, Colorado 80522, USA.
Without antibiotic treatment, the Lyme-disease-causing bacterium, Borrelia burgdorferi can be cultured from the peripheral blood of human patients nearly 6 wk post-tick bite. To determine if Lyme disease spirochetes can be transmitted from a spirochetemic donor mouse to a naive recipient during blood transfusion, blood taken from immunocompetent infected mice was transfused into either immunodeficient (SCID) mice, inbred immunocompetent animals (C3H/HeJ), or outbred mice.
Nine of 19 (47.7%) immunodeficient mice, 7 of 15 (46.8%) inbred immunocompetent mice, and 6 of 10 (60.0%) outbred mice became infected with B. burgdorferi after transfusion.
Our results indicate that it is possible to acquire B. burgdoferi infection via transfused blood in a mouse model of Lyme borreliosis.
PMID: 16995409 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Vox Sang. 2006 Apr;90(3):157-65. Links
Babesiosis and blood transfusion: flying under the radar.
* Leiby DA.
Department of Transmissible Diseases, Jerome H. Holland Laboratory for the Biomedical Sciences, American Red Cross, Rockville, MD 20855, USA. [email protected]
Infectious agents of disease continue to plague transfusion medicine as an increasing number of pathogens are described that pose a potential blood safety risk. While the recent focus has been on newly emerged agents, several well-established pathogens provide timely reminders that other agents continue to pose threats, but invariably 'fly under the radar', thereby failing to elicit adequate measures to prevent their transmission by blood transfusion.
Perhaps foremost among this group of agents are the Babesia spp., which have been known to cause human disease, in the USA, for close to 40 years. B. microti, B. divergens and several Babesia-like agents are responsible for a growing number of human babesiosis infections.
Concomitantly, in the USA, there has been a sharp rise in the number of transfusion-transmitted infections of Babesia spp., attributable almost exclusively to B. microti.
Despite the obvious public health issues posed by Babesia spp., options for preventing their transmission by blood transfusion remain limited. However, recognition that the Babesia spp. are indeed an ongoing and expanding blood safety threat will probably prove instrumental in the development of viable interventions to limit transmission of these agents.
PMID: 16507014 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transfus Med Rev. 2004 Oct;18(4):293-306. Links
Transfusion-transmitted tick-borne infections: a cornucopia of threats.
* Leiby DA, Gill JE.
Department of Transmissible Diseases, American Red Cross Holland Laboratory, Rockville, MD 20855, USA. [email protected]
Over the past several decades, the frequency of contact between humans and ticks has increased dramatically. Concomitantly, several newly recognized tick-borne pathogens have emerged joining those already known to be transmitted by ticks. Together these factors have led to an enhanced public health awareness of ticks, tick-borne agents, and their associated diseases. Reports that several of these agents are transmitted by blood transfusion have raised concerns about blood safety.
The primary agents of interest are members of the genus Babesia, but Anaplasma phagocytophilum, Rickettsia rickettsii, Colorado tick fever virus, and tick-borne encephalitis virus also have been transmitted by transfusion. In many cases, these agents and their diseases share common features including vectors, symptoms, and diagnosis. Unfortunately, they also share the common problem of insufficient epidemiologic and transmissibility data necessary for making informed decisions regarding potential blood safety interventions.
Although further surveillance and epidemiologic studies of tick-borne agents are clearly needed, at present only the Babesia warrant consideration for active intervention; because donor management strategies based on risk-factor questions are inadequate, leukoreduction not effective for agents found in red cells and pathogen inactivation remains problematic for red cell products.
Despite the present unavailability of screening assays, some form of serologic and nucleic acid testing may be justified for the Babesia. Given that interactions between humans and ticks are likely to increase in the future, vigilance is required as new and extant tick-borne agents pose potential threats to transfusion safety.
PMID: 15497129 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Curr Opin Hematol. 2003 Nov;10(6):405-11. Links
Risk and prevention of transfusion-transmitted babesiosis and other tick-borne diseases.
* Cable RG, Leiby DA.
American Red Cross, Connecticut Blood Services, Farmington, and University of Connecticut Health Center, Farmington, Connecticut 06032, USA. [email protected]
PURPOSE OF REVIEW: Tick-borne diseases have increasingly been recognized in the United States as public health problems. The importance of tick-borne diseases has been accelerated by increases in animal populations, as well as increased human recreation in wooded environments that are conducive to tick bites. Babesiosis, usually caused by the intraerythrocytic parasite, Babesia microti and transmitted by the same tick as Lyme disease, has important transfusion implications. Although Lyme disease has not been reported from blood transfusion, newly identified tick-borne diseases such as ehrlichiosis raise additional questions about the role of the tick in transfusion-transmitted diseases.
RECENT FINDINGS: The risk of transfusion-transmitted babesiosis is higher than usually appreciated and in endemic areas represents a major threat to the blood supply. Furthermore, the geographic range of B. microti is expanding, other Babesia spp. have been implicated in transfusion transmission in the western United States, and the movement of blood donors and donated blood components may result in the appearance of transfusion babesiosis in areas less familiar with these parasites. Consequently, a higher degree of clinical suspicion will allow early recognition and treatment of this important transfusion complication.
SUMMARY: In endemic areas transfusion-transmitted babesiosis is more prevalent than usually believed. The extension of the geographic range of various Babesia spp. and the movement of donors and blood products around the United States has resulted in the risk extending to non-endemic areas. Clinicians should maintain a high degree of clinical suspicion for transfusion-transmitted babesiosis.
PMID: 14564169 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transfus Med Rev. 2002 Apr;16(2):131-43. Links
The impact of babesiosis on transfusion medicine.
* Pantanowitz L, Telford SR 3rd, Cannon ME.
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard School of Public Health, 330 Brookline Avenue, Boston, MA 02215, USA.
Babesiosis is an emerging zoonotic disease that has begun to have a noticeable impact on transfusion medicine. This is reflected in the growing medical literature on the topic. There has been no review to summarize the various ways in which babesiosis influences transfusion medicine. Babesiosis is the most frequently reported tick-borne pathogen to be transmitted by blood transmission.
Until recently, it has been an underrecognized complication of blood transfusion. However, the increased use of blood products for an ever-increasing elderly and immunodeficient patient population has heightened awareness about this disease. Fortunately, the risk of acquiring a symptomatic infection through a blood transfusion is surprisingly low.
Nevertheless, babesiosis should be included in the differential diagnosis of a febrile hemolytic illness in recipients of blood transfusions. Infected individuals who become chronic carriers and donate blood during asymptomatic periods pose the greatest risk to the blood supply.
The exact risk that this parasite poses to our blood supply remains to be accurately assessed. Reported cases of transmission, to date, have involved only the transfusion of red blood cells (RBCs) and, more rarely, platelets. Transmission of these piroplasms through plasma alone has not been documented. Much of our understanding about this organism evoked host responses and its requirements for in vitro survival has come from studies on non-human vertebrates. These studies have shown that antigenic variation may play a significant role in the development of prolonged parasitemia, that complement-induced changes to erythrocytes are pivotal in facilitating protozoan entry into host RBCs, and that autoimmunity contributes to disease. Severe infections may require lifesaving exchange transfusions and even plasmapheresis.
Controlled studies to clearly define specific indications, benefits, and objectives of this therapy are still needed. Despite the development of novel and improved diagnostic tests, these tests are not readily available for the mass screening of blood donors. Improved strategies to assess and prevent transfusion-associated babesiosis are required. Current measures cannot be relied on to identify infected donors with a high degree of sensitivity or to protect susceptible recipients from this parasite. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 11941575 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transplantation. 2000 Jul 15;70(1):205-8. Links
Babesiosis in a renal transplant recipient acquired through blood transfusion.
Department of Surgery, Hartford Hospital, CT 06102, USA.
BACKGROUND: The success of organ-replacement therapies has resulted in a population of chronically immunosuppressed but active people who experience increased vulnerability to tick-borne zoonoses. Several of these infections may be life threatening. Human babesiosis is an emerging zoonosis that is transmitted by the same tick that transmits Lyme disease and human granulocytic ehrlichiosis.
METHODS: We briefly review these zoonoses and present a case of a renal transplant recipient who survived infection by Babesia microti contracted through blood transfusion.
RESULTS: A recipient of a living-related renal transplant developed acute postoperative hemolytic anemia. The etiology of this anemia was diagnosed by peripheral red blood cell smear as Babesia microti. The patient was managed by a reduction in transplant immunosuppressive therapy and administration of clindamycin and quinine antimicrobials.
CONCLUSIONS: Transplant patients may contract babesiosis after tick exposure and/or via blood transfusion. The diagnosis of babesiosis may be confused with malaria and should be included in the differential diagnosis of posttransplant hemolytic-uremic syndrome in organ transplant patients.
PMID: 10919602 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Emerg Infect Dis. 2003 Jan;9(1):116-9. Links
Transfusion-associated babesiosis after heart transplant.
* Lux JZ, Weiss D, Linden JV, Kessler D, Herwaldt BL, Wong SJ, Keithly J, * Della-Latta P, Scully BE.
Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
We describe a 54-year-old spleen-intact man with transfusion-associated Babesia microti infection after a heart transplant. Adult respiratory distress syndrome developed in the patient, and he required mechanical ventilation.
Our experiences with this patient suggest that babesiosis should be considered in the differential diagnosis of transplant patients who have fever and hemolytic anemia.
PMID: 12533293 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transfusion. 2002 Nov;42(11):1482-7. Links
Investigation of transfusion transmission of a WA1-type babesial parasite to a premature infant in California.
* Kjemtrup AM, Lee B, Fritz CL, Evans C, Chervenak M, Conrad PA.
Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis 95616-8745, USA.
BACKGROUND: A premature infant in California developed respiratory distress associated with infection with a protozoal parasite, Babesia. The infant had received two blood transfusions, one from the father and one from an anonymous donor (Donor A). This study describes the follow-up required to identify the source and species of Babesia that infected the infant.
STUDY DESIGN AND METHODS: At the time of the infant's illness, whole blood from the infant, father, and mother was evaluated for Babesia infection. Similar evaluation of whole blood from Donor A was performed 2 months after the suspected donation to the infant. Samples were tested using blood smear examination, serology, PCR, and hamster inoculation. Identity of the recovered Babesia parasites was confirmed by DNA amplification by PCR, genetic sequencing of the 18S gene, and phylogenetic analysis.
RESULTS: WA1-type Babesia was recovered from the infant. Neither parent was the source of infection. Serology and hamster inoculation confirmed WA1-type Babesia infection in Donor A. DNA sequences of the 18S gene from the infant and donor isolates were 100% identical.
CONCLUSION: WA1-type Babesia infections may be difficult to detect among blood donors because such infections can be subclinical. This is the second WA1-type Babesia transmission via blood transfusion and the first in an infant. Physicians in the western United States should consider Babesia as a possible cause of nonspecific febrile illness after a blood transfusion.
PMID: 12421222 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transfusion. 2002 Sep;42(9):1154-8. Links
Transmission of Babesia microti in Minnesota through four blood donations from the same donor over a 6-month period.
*Herwaldt BL, Neitzel DF, Gorlin JB, Jensen KA, Perry EH, Peglow WR, Slemenda SB, Won KY, Nace EK, Pieniazek NJ, Wilson M.
Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA. [email protected]
BACKGROUND: Babesiosis is a tick-borne zoonosis caused by intraerythrocytic protozoa. More than 40 US cases of Babesia microti infection acquired by blood transfusion have been reported. This report describes the identification of a transfusion-associated case of babesiosis and the subsequent identification of the infected blood donor and three other infected recipients of cellular blood components from three other donations by this donor.
STUDY DESIGN AND METHODS: Serum specimens from the donors of blood that had been made into cellular components received by the index recipient and from other recipients of such components from the implicated donor were tested by the indirect fluorescent antibody (IFA) assay for antibodies to B. microti. Whole blood from IFA-positive persons was tested by PCR for B. microti DNA.
RESULTS: IFA testing of serum from 31 of 36 donors implicated a 45-year-old man (titer, 1 in 256), whose donation had been used for RBCs. He likely became infected when bitten by ticks while camping in Minnesota in June 1999 and had donated blood four times thereafter. As demonstrated by PCR, he remained parasitemic for at least 10 months. Of the five other surviving recipients of cellular blood components from the implicated donor, three recipients (one for each of the three other donations) had become infected through either RBC or platelet transfusions.
CONCLUSIONS: Babesiosis should be included in the differential diagnosis of posttransfusion febrile illness, and effective means for preventing transmission by blood transfusion are needed.
PMID: 12430672 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transfus Med. 2002 Apr;12(2):85-106. Links
Tick-borne diseases in transfusion medicine.
* Pantanowitz L, Telford SR, Cannon ME.
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. [email protected]
Ticks are effective vectors of viral, bacterial, rickettsial and parasitic diseases. Many of the tick-borne diseases (TBDs) are of significance to transfusion medicine, either because of the risks they pose to the blood supply or the necessity for blood products required in their treatment.
The transmission of tick-borne pathogens via blood transfusion is of global concern. However, among transfusion medicine practitioners, experience with most of these microorganisms is limited. Transfusion transmission of TBDs has been documented largely by means of single case reports.
A better understanding of the epidemiology, biology and management of this group of diseases is necessary in order to assess the risks they pose to the blood supply and to help guide effective prevention strategies to reduce this risk. Unique methods are required to focus on donor selection, predonation questioning, mass screening and inactivation or eradication procedures. The role of the transfusion medicine service in their treatment also needs to be better defined. This article reviews the growing body of literature pertaining to this emerging field of transfusion medicine and offers some recommendations for transfusionists in dealing with TBDs.
PMID: 11982962 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transfusion. 1989 Sep;29(7):581-3.
Survival of Borrelia burgdorferi in blood products.
Badon SJ, Fister RD, Cable RG.
American Red Cross Blood Services, Farmington, Connecticut.
The incidence of Lyme disease is rapidly increasing in the United States. To assess the potential of transmission of the disease through blood transfusion, we studied the survival of Borrelia burgdorferi in blood products under blood bank storage conditions.
Two units of whole blood, separated into red cells (RBCs), fresh-frozen plasma (FFP), and platelet concentrates (PCs), were inoculated with B. burgdorferi (strain B31) in concentrations of approximately 3000 organisms per mL of RBCs and FFP and 200 organisms per mL of PCs. Products were then stored under blood banking conditions and sampled at several storage times. The viability of the spirochete in blood components was determined by darkfield microscopic examination of cultures in modified Kelly's medium.
The organism was shown to survive in RBCs (4 degrees C) and FFP (below -18 degrees C) for 45 days and in PCs (20-24 degrees C) for 6 days. The results of this study do not exclude the possibility of transmission of Lyme disease through blood transfusion.
PMID: 2773025 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
and a few more...
Transfusion. 2000 Sep;40(9):1041-7. Links
Survival of Ehrlichia chaffeensis in refrigerated, ADSOL-treated RBCs.
Viral and Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
BACKGROUND: The purpose of this study was to investigate the persistence of viable Ehrlichia chaffeensis in ADSOL-treated RBCs stored at 4 to 6 degrees C.
STUDY DESIGN AND METHODS: The continuous monocytic cell lines THP-1 and DH82 were infected with E. chaffeensis (St. Vincent isolate). Packed RBC units were inoculated in separate experiments with E. chaffeensis-infected cells as final concentrations of 8.02 x 10(4) (DH82) and 1.43 x 10(4) (THP-1) infected cells per mL. Aliquots were stored at 4 to 6 degrees C for 1 to 42 days. At selected intervals, nucleated cells from the RBC aliquots were obtained by using a ficoll-isopaque separation procedure. Uninfected DH82 cell cultures were inoculated with the harvested nucleated cells or supernatant. The cell cultures were evaluated for infection by weekly examination of Wright's (Diff-Quik) stained cytocentrifuged slides. PCR amplification was also used to test the harvested nucleated cells or supernatant for the presence of E. chaffeensis DNA.
RESULTS: In both types of infected cell lines, E. chaffeensis was reisolated in DH82 cells for as long as 11 days from the cellular fraction and for up to 5 days from the supernatant fraction. PCR results were positive throughout the 42-day testing period.
CONCLUSION: Cell-associated E. chaffeensis remains viable in ADSOL-treated RBCs stored at 4 to 6 degrees C for at least 11 days. These data suggest that transfusion-acquired infection is possible. Successful reisolation was achieved from the supernatant fraction, which suggests that RBC products treated with a WBC-reduction procedure may still present a risk for transfusion transmission. No correlation between PCR positivity and viability of bacteria was noted.
PMID: 10988303 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
One from the WORMser
J Clin Microbiol. 2000 Jun;38(6):2398-9. Links
Survival of the human granulocytic ehrlichiosis agent under refrigeration conditions.
* Kalantarpour F, Chowdhury I, Wormser GP, Aguero-Rosenfeld ME.
Department of Medicine, Division of Infectious Diseases, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
The human granulocytic ehrlichiosis (HGE) agent in infected blood specimens remained viable during refrigeration at 4 degrees C for up to 18 days.
These findings suggest that blood specimens submitted for culture may withstand transportation to a remote laboratory. HGE should be added to the list of infections potentially transmitted by blood transfusion.
PMID: 10835014 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
JAMA. 1978 Jun 30;239(26):2763-5. Links
Rocky mountain spotted fever caused by blood transfusion.
* Wells GM, Woodward TE, Fiset P, Hornick RB.
Transfusion of 500 ml of blood, contributed by a donor three days before the onset of Rocky Mountain spotted fever and refrigerated for nine days, caused this disease in the recipient.
The blood donor died of Rocky Mountain spotted fever after six days; rickettsia were identified in various tissues by immunofluorescence techniques.
The recipient of the blood became mildly ill and recovered fully; specific antibiotic treatment was initiated on the fourth day of illness. Diagnosis of Rocky Mountain spotted fever was confirmed in the recipient by positive serologic reactions and isolation of Rickettsia rickettsii from blood after inoculation in animals and tissue culture.
PMID: 418193 [PubMed - indexed for MEDLINE]
Posted by Melanie Reber (Member # 3707) on :
Goodness Ima, you HAVE been busy!
GREAT work here. I am going to link it to the donor thread for more information.
Thank you SO much! Especially for letting me know about that last citation that I just added to the Memorial site.
Much love, M
Posted by trueblue (Member # 7348) on :
quote:Originally posted by Melanie Reber: Goodness Ima, you HAVE been busy!
GREAT work here. I am going to link it to the donor thread for more information.
Thank you SO much! Especially for letting me know about that last citation that I just added to the Memorial site.
Much love, M
What melanie said! thanks for all the info. She beat me to the punch looking through to see if there was anythign for the memorial site.
You guys are good. Posted by bettyg (Member # 6147) on :
ima, great links! thanks for taking the time for all of us.
would you copy your link and post it in treepatrol's newbie links archive, so he can add it next time he updates things so it's not lost; thanks!
hope you are feeling better. Posted by pineapple (Member # 11904) on :
J Med Virol. 2007 Aug;79(8):1229-37. Links
Verses, viruses, and the vulnerability of the blood supply in industrialized countries.
Mushahwar IK. Infectious Disease Diagnostics, Tierra Verde, Florida 33715, USA. [email protected]
In the last 30 years, tremendous progress in identifying transfusion-transmitted viruses such as HBV, HCV, and HIV in industrialized countries has been achieved. Currently, the residual risk of transmitting these viruses through transfusion is very low especially after the introduction of "minipool" nucleic acid-amplification tests. Despite these major technical advances, there remains a legitimate concern as to the transmission of other blood-borne infectious agents through blood transfusion.
Among these agents are HBV mutants, occult HBV, and HCV infections, malaria, Chagas, West Nile, dengue, and vesiviruses, bacterial infections such as Yersinia enterocolitica, and tick borne diseases such as human monocytic ehrlichiosis, human granulocytic ehrlichiosis, Rocky Mountain spotted fever, and Lyme and prion diseases such as Creutzfeldt and variant Creutzfeldt. Most of these agents are very rarely transmitted by transfusion in industrialized countries. However, an awareness of their possible transmission is essential for the control of spread of these diseases among the public by human-to-human transmission via blood transfusion.
This review summarizes the current status of prevalence and diagnosis of these emerging diseases and also updates our knowledge on recently discovered non-pathogenic blood-borne viruses such as GB virus C and Torque Tenoviruses.
PMID: 17596828 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Transfusion Volume 42 Issue 12 Page 1585-1591, December 2002
Relationship between tick bites and the seroprevalence of Babesia microti and Anaplasma phagocytophila (previously Ehrlichia sp.) in blood donors
David A. Leiby, Amy P.S. Chung, Ritchard G. Cable, Jonathan Trouern-Trend, Jeffrey McCullough, Mary J. Homer, Lisa D. Reynolds, Raymond L. Houghton, Michael J. Lodes, and David H. Persing
From the Transmissible Diseases Department, American Red Cross, Rockville, Maryland; Connecticut Region, American Red Cross, Farmington, Connecticut; North Central Region, American Red Cross, St. Paul, Minnesota; Corixa Corporation, Seattle, Washington; Divisions of Clinical Microbiology and Experimental Pathology, Mayo Clinic and Foundation, Rochester, Minnesota.
____Abstract____
BACKGROUND: Tick-borne diseases, particularly babesiosis and ehrlichiosis, represent recently emerging infections. Despite an increased recognition of the threat tick-borne agents pose to blood safety, our understanding of the prevalence and transmissibility of these agents in blood donors is limited.
STUDY DESIGN AND METHODS: Babesia microti and Anaplasma phagocytophila (previously Ehrlichia sp.) seroprevalence was determined in random Connecticut and Wisconsin donors, and subsequently in Connecticut donors reporting tick bites. In the interim, a postcard survey regarding tick bites during the previous 6 months was sent to 6000 random donors in six geographically distinct collection regions.
RESULTS: In total, 3 of 999 Wisconsin donors (0.3%) and 6 of 1007 Connecticut donors (0.6%) had antibodies to B. microti. Of 992 donors tested for A. phagocytophila, 5 Wisconsin donors (0.5%) and 35 Connecticut donors (3.5%) were seropositive. A total of 2482 donors (41.4%) completed the survey; 103 (4.1%) reported a tick bite. Of 848 Connecticut donors (0.4%) reporting tick bites, 3 had B. microti antibodies, while 8 (0.9%) had A. phagocytophila antibodies. These rates were not significantly different from control donors.
CONCLUSION: Blood donors seropositive for B. microti and A. phagocytophila are present in Connecticut and Wisconsin. Donors readily recall previous tick bites, but self-reported bites are not reliable indicators of serologic status. The exposure of blood donors to tick-borne pathogens does suggest a need to better understand the transfusion transmission potential of these agents.
Posted by imanurse (Member # 7022) on :
Transfusion Volume 45 Issue 11 Page 1804-1810, November 2005
TRANSFUSION COMPLICATIONS
Demonstrable parasitemia among Connecticut blood donors with antibodies to Babesia microti
David A. Leiby, Amy P.S. Chung, Jennifer E. Gill, Raymond L. Houghton, David H. Persing, Stanley Badon, Ritchard G. Cable
-From the Department of Transmissible Diseases, American Red Cross, Rockville, Maryland; Corixa Corp., Seattle, Washington; and the Connecticut Region, American Red Cross, Farmington, Connecticut.
This study was supported by the American Red Cross, Biomedical Services.
___Abstract____
BACKGROUND: Reports of transfusion-transmitted Babesia microti have risen steadily during the past several years, reflecting a concurrent increase in US cases of human babesiosis. Although several studies have measured B. microti antibodies in blood donors, little is known about associated parasitemia and the inherent risk of transmitting the parasite by transfusion.
STUDY DESIGN AND METHODS: Donations from blood donors located in Babesia-endemic and nonendemic areas of Connecticut were tested for B. microti antibodies from July through September. Subsequently, an additional blood sample was collected from selected seropositive donors and tested by nested polymerase chain reaction (PCR) for B. microti nucleic acids.
RESULTS: A total of 3490 donations, 1745 each from endemic and nonendemic areas, were tested for B. microti antibodies; 30 (0.9%) were confirmed as positive and seroprevalence rates peaked in July. Significantly more seropositive donations were from endemic areas (24, 1.4%) than nonendemic areas (6, 0.3%). Ten (53%) of 19 seropositive donors subsequently tested by PCR were positive.
CONCLUSION: B. microti seroprevalence was highest in those areas of Connecticut where the parasite is endemic. More than half of seropositive donors tested had demonstrable parasitemia, indicating that many are at risk for transmitting B. microti by blood transfusion. Three donors were identified as parasitemic in October, suggesting that donors may be at risk for transmitting the parasite outside of the peak period of community-acquired infection.
Posted by imanurse (Member # 7022) on :
Transfusion Volume 31 Issue 4 Page 365-368, May 1991
Transfusion-transmitted babesiosis: a case report from a new endemic area
ED Mintz, JF Anderson, RG Cable, JL Hadler
Connecticut Department of Health Services, Hartford.
____Abstract____
The seventh documented case of babesiosis transmitted by transfusion is reported. Both the donor and the recipient are residents of Connecticut, where the presence of endemic babesiosis has only recently been established. As the range of Babesia microti, and its vector the Ixodes dammini tick, continues to expand, clinicians and blood bank directors should be aware that cases of transfusion-transmitted babesiosis may occur in newly endemic areas.
Posted by imanurse (Member # 7022) on :
Transfusion Volume 40 Issue 3 Page 285-289, March 2000
Transfusion-associated transmissionof babesiosis in New York State
J.V Linden, S.J Wong, F.K Chu, G.B Schmidt, C Bianco
From the Wadsworth Center, New York State Department of Health, Albany, New York; and the New York Blood Center, New York, New York.
Supported in part by Grant 815-3478A from the Centers for Disease Control and Prevention of the Public Health Service.
___Abstract___
BACKGROUND: Babesiosis can be life-threatening in immunocompromised individuals. Although the disease is usually transmitted by tick bite, more than 20 cases have been reported of infection transmitted by transfusion of blood or blood components obtained from apparently healthy donors from endemic areas in the United States. This report describes several recent cases of transfusion-transmitted babesiosis in New York State.
STUDY DESIGN AND METHODS: Transfusion-associated incidents of babesiosis infection were identified and investigated. Seroprevalence of babesiosis in healthy blood donors in a highly endemic area was ascertained.
RESULTS: In three incidents, babesiosis was diagnosed in five of eight patients given infected blood: two premature infants, an elderly patient with gastrointestinal bleeding, and two patients with thalassemia. Seroprevalence in blood donors on Shelter Island (Suffolk County, eastern Long Island), a highly endemic area, was 4.3 percent in May 1998.
CONCLUSIONS: Infected donors lived in endemic areas and were asymptomatic with no history of tick bite. Blood collected in January 1997 from one donor was infectious. Those transfusion recipients who were infected were neonatal, elderly, or chronically transfused patients. Babesiosis should be included in the differential diagnosis of febrile illness in immunocompromised recipients of blood transfusion, particularly in the Northeastern United States.
Posted by imanurse (Member # 7022) on :
Transfusion Volume 30 Issue 4 Page 298-301, May 1990
Survival of Borrelia burgdorferi in human blood stored under blood banking conditions
RB Nadelman, C Sherer, L Mack, CS Pavia, GP Wormser
Department of Medicine, New York Medical College, Valhalla.
___Abstract___
Hematogenous dissemination of organisms occurs in many spirochetal diseases, including Lyme disease and syphilis. Although syphilis has been transmitted by transfusion, in the vast majority of cases, only fresh blood products were involved, in part because Treponema pallidum survives poorly when refrigerated in citrated blood.
Because of the rising incidence of Lyme disease in certain areas, whether its causative agent, Borrelia burgdorferi, could survive under blood banking conditions was studied. Dilutions of stock cultures of two strains of B. burgdorferi were inoculated into samples of citrated red cells (RBCs). Viable spirochetes were recovered from RBCs inoculated with 10(6) organisms per mL, after refrigeration for as long as 6 weeks. It is concluded that B. burgdorferi may survive storage under blood banking conditions and that transfusion-related Lyme disease is theoretically possible.
Posted by MustBeaPony (Member # 11179) on :
Thanks for the material!
Explains tons - had sx prior to a 'fatal' accident in '95, mysteriously dxd MS in '99, correctly dxd lyme, babs, bart, etc in late '06.
I always wondered if the accident activated the creatures or if it was the 3 units of blood I rec'd in NH.
Glad to be alive, as I bled to death so I guess the correct Lyme dx is shot #3 at life!
Posted by seibertneurolyme (Member # 6416) on :
I think a couple of these abstracts fit the bill to send to the I.D. doc who told me there was no such thing as chronic Babesia.
Bea Seibert
Posted by sizzled (Member # 1357) on :
Thanks!
Posted by imanurse (Member # 7022) on :
Clin Infect Dis. 2009 Jan 1;48(1):25-30.
Babesia infection through blood transfusions: reports received by the US Food and Drug Administration, 1997-2007.
Gubernot DM, Lucey CT, Lee KC, Conley GB, Holness LG, Wise RP. Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Rockville, Maryland 20852-1448, USA. [email protected]
BACKGROUND: Human babesiosis is an illness with clinical manifestations that range from asymptomatic to fatal. Although babesiosis is not nationally notifiable, the US incidence appears to be increasing. Babesia infection is a transfusion-transmissable disease. An estimated 70 cases were reported during 1979-2007; most of these cases were reported during the past decade.
METHODS: We queried the 3 following US Food and Drug Administration safety surveillance systems to assess trends in babesiosis reporting since 1997: fatality reports for blood donors and transfusion recipients, the Adverse Event Reporting System (which includes MedWatch), and the Biological Product Deviations Reporting system.We analyzed fatality reports for time frames, clinical presentations, and patient and donor demographic characteristics.
RESULTS: Eight of 9 deaths due to transfusion-transmitted babesiosis that were reported since 1997 occurred within the past 3 years (2005-2007). Four implicated donors and 5 patients lived in areas where Babesia infection is not endemic. Increasing numbers of Biological Product Deviations Reports were submitted to the US Food and Drug Administration over the past decade; the Adverse Event Reporting System received no reports.
CONCLUSIONS: After nearly a decade with no reported death due to transfusion-transmitted babesiosis, the US Food and Drug Administration received 8 reports from November 2005 onward. The increased numbers of deaths reported and Biological Product Deviations Reports suggest an increasing incidence of transfusion-transmitted babesiosis.
Physicians should consider babesiosis in the differential diagnosis in immunocompromised, febrile patients with a history of recent transfusion, even in areas where Babesia infection is not endemic. Accurate and timely reporting of babesiosis-related donor and transfusion events assists the US Food and Drug Administration in developing appropriate public health-control measures.
PMID: 19035776 [PubMed - in process]
Posted by imanurse (Member # 7022) on :
Transfusion. 2008 Aug 6.
Fatal transfusion-transmitted Babesia microti in the Midwest.
Blue D, Graves V, McCarthy L, Cruz J, Gregurek S, Smith D. Indiana University Medical Center, Clarian Health, and the Indiana Blood Center, Indianapolis, Indiana, USA.
PMID: 18694463 [PubMed - as supplied by publisher]
Posted by imanurse (Member # 7022) on :
Transfusion. 2008 Aug;48(8):1676-84. Epub 2008 May 22.
Photochemical inactivation with amotosalen and long-wavelength ultraviolet light of Plasmodium and Babesia in platelet and plasma components.
Grellier P, Benach J, Labaied M, Charneau S, Gil H, Monsalve G, Alfonso R, Sawyer L, Lin L, Steiert M, Dupuis K. Biologie Fonctionnelle des Protozoaires, Mus�um National d'Histoire Naturelle, Paris, France.
BACKGROUND: Transfusion-transmitted cases of malaria and babesiosis have been well documented. Current efforts to screen out contaminated blood products result in component wastage due to the lack of specific detection methods while donor deferral does not always guarantee safe blood products. This study evaluated the efficacy of a photochemical treatment (PCT) method with amotosalen and long-wavelength ultraviolet light (UVA) to inactivate these agents in red blood cells (RBCs) contaminating platelet (PLT) and plasma components.
STUDY DESIGN AND METHODS: Plasmodium falciparum- and Babesia microti-contaminated RBCs seeded into PLT and plasma components were treated with 150 micromol per L amotosalen and 3 J per cm2 UVA. The viability of both pathogens before and after treatment was measured with infectivity assays. Treatment with 150 micromol per L amotosalen and 1 J per cm2 UVA was used to assess the robustness of the PCT system.
RESULTS: No viable B. microti was detected in PLTs or plasma after treatment with 150 mol per L amotosalen and 3 J per cm2 UVA, demonstrating a mean inactivation of greater than 5.3 log in PLTs and greater than 5.3 log in plasma. After the same treatment, viable P. falciparum was either absent or below the limit of quantification in three of four replicate experiments both in PLTs and in plasma demonstrating a mean inactivation of at least 6.0 log in PLTs and at least 6.9 log in plasma. Reducing UVA dose to 1 J per cm2 did not significantly affect the level of inactivation.
CONCLUSION: P. falciparum and B. microti were highly sensitive to inactivation by PCT. Pathogen inactivation approaches could reduce the risk of transfusion-transmitted parasitic infections and avoid unnecessary donor exclusions.
PMID: 18503613 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Pediatr Infect Dis J. 2006 Feb;25(2):169-73.
Neonatal babesiosis: case report and review of the literature.
Fox LM, Wingerter S, Ahmed A, Arnold A, Chou J, Rhein L, Levy O. Division of Infectious Diseases, Children's Hospital Boston, Harvard Medical School, Boston, MA. [email protected]
A case of transfusion-associated neonatal babesiosis is presented. Jaundice, hepatosplenomegaly, anemia and conjugated hyperbilirubinemia developed in this preterm infant. The diagnosis was eventually made by blood smear, serology and polymerase chain reaction. The patient was treated with clindamycin and quinine and made a favorable recovery. Of neonatal babesiosis reported in the literature, 9 other cases are reviewed, including 6 that were transfusion-associated, 2 congenital and 2 tick transmitted.
PMID: 16462298 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
Pediatr Infect Dis J. 2007 Feb;26(2):181-3.
Atovaquone and azithromycin treatment for babesiosis in an infant.
Raju M, Salazar JC, Leopold H, Krause PJ. Division of Infectious Diseases, Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA.
An 8-month-old infant with cyanotic heart disease and transfusion-associated Babesia microti infection is reported here. At initial presentation, she was ill appearing, febrile and cyanotic. Laboratory tests revealed severe anemia, thrombocytopenia and an increase in hepatic enzymes. The diagnosis was made by the presence of intraerythrocytic parasites on thin blood smear and confirmed by serology and polymerase chain reaction. The infant was treated successfully with a combination of oral azithromycin and atovaquone. This combination is an alternative to clindamycin and quinine for the treatment of children with babesiosis.
PMID: 17259886 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
First confirmed autochthonous case of human Babesia microti infection in Europe.
Hildebrandt A, Hunfeld KP, Baier M, Krumbholz A, Sachse S, Lorenzen T, Kiehntopf M, Fricke HJ, Straube E. Institute of Medical Microbiology, Friedrich Schiller University, Semmelweiss Str. 4, 07743, Jena, Germany. [email protected]
A 42-year-old female patient with acute myeloid leukemia presented with fever and heavy chest pain after her first cycle of specific chemotherapy. Acute myocardial infarction was excluded, but surprisingly, parasitic inclusions in erythrocytes became obvious in Pappenheim and Giemsa-stained peripheral blood smears. The patient did not remember a tick bite but acknowledged having received several blood transfusions in her recent medical history.
Suspicion of malaria was ruled out by use of a dip-stick test. The diagnosis of Babesia microti infection was finally established by specific polymerase chain reaction (PCR). Six weeks after initiation of specific treatment, PCR turned negative and a positive immunoflourescence assay (IFA) with an IgG titer of 1:128 indicated seroconversion. Subsequent screening of donors involved in the transfusion of blood products to the patient demonstrated borderline reactivity for Babesia microti (IgG-titer 1:32) in 1 out of 44 individuals. Neither the patient nor the positively tested blood donor had travelled to North America or Asia. Therefore, this is the first confirmed autochthonous human infection in Europe.
PMID: 17587072 [PubMed - indexed for MEDLINE]
Posted by imanurse (Member # 7022) on :
MMWR Morb Mortal Wkly Rep. 2008 Oct 24;57(42):1145-8.
Anaplasma phagocytophilum transmitted through blood transfusion--Minnesota, 2007.
Centers for Disease Control and Prevention (CDC). PMID: 18946461 [PubMed - indexed for MEDLINE]
Excerpt: "The case described in this report provides strong presumptive evidence that A. phagocytophilum infection in this patient was acquired through blood transfusion.......
A. phagocytophilum DNA was found in a retained sample from the implicated RBC product that was transfused to the recipient, providing strong evidence that this was the likely route of disease transmission to the blood transfusion recipient.
Some blood transfusion recipients (i.e., those who are immune compromised) likely are at increased risk for developing severe complications associated with tickborne diseases. Both A. phagocytophilum and E. chaffeensis can survive in refrigerated RBCs, and possible transfusion-transmission cases have been reported for anaplasmosis (Minnesota Department of Health, unpublished data, 1998) (2,3,5,6). However, because of the rarity of transfusion-associated cases, concerns regarding the specificity of available tests, (none of which are approved by the Food and Drug Administration), and the economic costs associated with implementation, the U.S. blood supply is not routinely screened for tickborne disease using laboratory methods (7).
As a method to reduce the risk for certain pathogens in blood products, blood banks often defer donations if the potential donor is ill at the time of donation. However, persons infected with tickborne disease might experience mild illness or have asymptomatic infection, as was the case with the implicated donor in this report (1,3).
Screening donors for a recent history of tick bite is unlikely to identify high-risk donors, because this type of exposure frequently is not recalled by persons with anaplasmosis (3). In this case, the implicated donor did not recall a tick bite, although she did report contact with wooded habitat in an anaplasmosis-endemic area. Nearly 75% of the other blood donors in this investigation reported similar outdoor contact, making the screening of blood donors for tick-related exposures poorly predictive for possible infection. Because Ehrlichia and Anaplasma are associated with white blood cells, leukoreduction techniques would be expected to reduce the risk for Ehrlichia and Anaplasma transfusion-transmission through RBC components (5,8).
In the absence of effective screening tools to identify donors or products infected with the organisms, physicians should weigh the benefits of using leukoreduced blood components, to potentially reduce the risk for Ehrlichia and Anaplasma transmissions. "
Posted by imanurse (Member # 7022) on :
Transfus Med. 2008 Oct;18(5):287-91.
Bartonella henselae survives after the storage period of red blood cell units: is it transmissible by transfusion?
Magalh�es RF, Pitassi LH, Salvadego M, de Moraes AM, Barjas-Castro ML, Velho PE. Department of Medical Clinic, Dermatology Division, School of Medical Sciences, State University of Campinas, Campinas, S�o Paulo, Brazil. [email protected]
Bartonella henselae is the agent of cat scratch disease and bacillary angiomatosis. Blood donors can be asymptomatic carriers of B. henselae and the risk for transmission by transfusion should be considered. The objective of this study was to demonstrate that B. henselae remains viable in red blood cell (RBC) units at the end of the storage period.
Two RBC units were split into two portions. One portion was inoculated with B. henselae and the other was used as a control. All units were stored at 4 degrees C for 35 days. Aliquots were collected on a weekly basis for culture in a dish with chocolate agar, ideal for the cultivation of this agent. Samples were collected on days 1 and 35 and taken for culture in Bact/Alert R blood culture bottles. Aliquots taken simultaneously were fixed in Karnovsky's medium for subsequent electron microscopy evaluation. Samples from infected bags successfully isolated B. henselae by chocolate agar culture, although Bact/Alert R blood culture bottles remained negative. Bartonella spp. structures within erythrocytes were confirmed by electron microscopy.
The viability of B. henselae was demonstrated after a storage period of RBC units. These data reinforce the possibility of infection by transfusion of blood units collected from asymptomatic blood donors.
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