Correspondence
Prospective Evaluation of a Patient with Trypanosoma cruzi Infection Transmitted by Transfusion
N Engl J Med 1999; 341:1237-1239October 14, 1999
- Article
To the Editor:
Trypanosoma cruzi, the etiologic agent of Chagas' disease, is endemic in Latin America, with 16 million to 18 million people infected.1 The parasite is transmitted naturally by a triatome insect, but it can also be transmitted by blood transfusion. Despite recent studies in the United States that identified T. cruzi–seropositive blood donors,2,3 most of whom came from countries where the parasite is endemic, only three cases of transfusion-transmitted T. cruzi infection have been reported to date.3
In December 1997, during a research study, we identified a 60-year-old woman with multiple myeloma who was unintentionally transfused with a platelet concentrate from an asymptomatic donor who was subsequently confirmed to be positive for T. cruzi antibodies. To evaluate the patient for possible transfusion-transmitted T. cruzi infection, we tested stored and prospectively acquired blood specimens for T. cruzi antibodies with an enzyme immunoassay (Abbott Laboratories) and a radioimmunoprecipitation assay and for parasitemia with the polymerase chain reaction (PCR) and hemoculture.4 Enzyme immunoassay values remained near base line for 57 days after the transfusion and then increased, becoming positive for T. cruzi antibodies on day 100 (Figure 1Figure 1
Results of Enzyme Immunoassay for Antibodies against Trypanosoma cruzi in Blood Specimens Obtained from the Patient before and after Transfusion.). All specimens tested by PCR and hemoculture were positive, whereas only the specimen obtained 164 days after transfusion was positive on the radioimmunoprecipitation assay (Table 1Table 1
Results of Radioimmunoprecipitation Assay, PCR, and Hemoculture.). Parasites were isolated from the donor and the recipient; randomly activated polymorphic DNA analyses5 confirmed the homogeneity of the parasites. The patient had no symptoms of Chagas' disease. She died in August 1998, and death was attributed to multiple myeloma. There was no autopsy.This case of T. cruzi infection would probably have gone unrecognized if we had not been aware of the patient's exposure to a potentially infectious platelet concentrate. Previous cases in the United States involved immunosuppressed patients in whom fulminant Chagas' disease developed, representing sentinel cases among a larger population. In our patient, parasitemia was detectable more than 40 days before seroconversion to antibody-positive status, a delay perhaps influenced by the presence of myeloma. The delay, however, is irrelevant with respect to the identification of T. cruzi–positive blood donors in the United States, since such persons are likely to be chronically infected, immunocompetent immigrants with detectable antibodies.2,3 Indeed, the donor in this case was a 56-year-old woman born near Santiago, Chile, who was serologically and parasitologically positive for T. cruzi 33 years after emigration.
Factors influencing the transmission of T. cruzi through transfusion remain unclear but may include a difference in risk among various blood components. Previously, we identified 12 recipients of blood from T. cruzi–seropositive donors; all 12 were seronegative for T. cruzi, but only 2 had received platelets.2,3 In contrast, at least three of four reported cases of transfusion-transmitted T. cruzi infection in the United States (including the present case report) involved platelets. Although we cannot estimate the frequency of transfusion-transmitted T. cruzi infection, there will probably be more cases in the United States. Further research is required to assess the need for routine screening of blood donors for T. cruzi infection.
5 ReferencesDavid A. Leiby, Ph.D.
American Red Cross, Rockville, MD 20855Bruce A. Lenes, M.D.
American Red Cross, Miami, FL 33101Melinda A. Tibbals, B.S.
American Red Cross, Rockville, MD 20855Marilee T. Tames-Olmedo, B.S.
American Red Cross, Miami, FL 331011
Control of Chagas disease: report of a WHO expert committeeWHO Tech Rep Ser 1991;811:1-95
Medline2
Leiby DA ,Fucci MH ,Stumpf RJ . Trypanosoma cruzi in a low- to moderate-risk blood donor population: seroprevalence and possible congenital transmission. Transfusion 1999;39:310-315
CrossRef | Web of Science | Medline3
Leiby DA ,Read EJ ,Lenes BA , et al. Seroepidemiology of Trypanosoma cruzi, etiologic agent of Chagas' disease, in US blood donors. J Infect Dis 1997;176:1047-1052
CrossRef | Web of Science | Medline4
Wendel S, Brener Z, Camargo ME, Rassi A, eds. Chagas disease (American trypanosomiasis): its impact on transfusion and clinical medicine. Rio de Janeiro, Brazil: Sociedade Brasileira de Hematologia e Hemoterapia, 1992.
5
Fernandes CD ,Murta SM ,Ceravolo IP , et al. Characterization of Trypanosoma cruzi strains isolated from chronic Chagasic patients, triatomines and opossums naturally infected from the State of Rio Grande do Sul, Brazil. Mem Inst Oswaldo Cruz 1997;92:343-351
CrossRef | Web of Science | Medline
- Citing Articles (35)
Citing Articles
1
Richard J. Benjamin, Susan L. Stramer, David A. Leiby, Roger Y. Dodd, Margaret Fearon, Emma Castro. (2012) Trypanosoma cruzi infection in North America and Spain: evidence in support of transfusion transmission. Transfusionno-no
CrossRef2
Laura Tonnetti, Aaron M. Thorp, Heather L. Reddy, Shawn D. Keil, Raymond P. Goodrich, David A. Leiby. (2011) Evaluating pathogen reduction of Trypanosoma cruzi with riboflavin and ultraviolet light for whole blood. Transfusionno-no
CrossRef3
A. Assal, C. Corbi. (2011) Maladie de Chagas et transfusion sanguine : un problème parasitaire émergent dans les pays non endémiques. Transfusion Clinique et Biologique 18:2, 286-291
CrossRef4
Caryn Bern, Diana L. Martin, Robert H. Gilman. 2011. Acute and Congenital Chagas Disease. , 19-47.
CrossRef5
Claudio J. Salomon. (2011) First century of chagas' disease: An overview on novel approaches to nifurtimox and benznidazole delivery systems. Journal of Pharmaceutical Sciencesn/a-n/a
CrossRef6
Joaquim Gascon, Caryn Bern, María-Jesús Pinazo. (2010) Chagas disease in Spain, the United States and other non-endemic countries. Acta Tropica 115:1-2, 22-27
CrossRef7
M. Piron. (2010) Relevance of parasite infections outside South and Central America: Chagas disease and malaria. ISBT Science Series 5:n1, 213-218
CrossRef8
Anis Rassi, Anis Rassi, José Antonio Marin-Neto. (2010) Chagas disease. The Lancet 375:9723, 1388-1402
CrossRef9
James Smith, Gail Rock. (2010) Protein quality in Mirasol pathogen reduction technology-treated, apheresis-derived fresh-frozen plasma. Transfusion 50:4, 926-931
CrossRef10
Marie-Hélène El Ghouzzi, Elisabeth Boiret, Françoise Wind, Claudine Brochard, Sébastien Fittere, Luc Paris, Dominique Mazier, Nicole Sansonetti, Philippe Bierling. (2010) BLOOD DONORS AND BLOOD COLLECTION: Testing blood donors for Chagas disease in the Paris area, France: first results after 18 months of screening. Transfusion 50:3, 575-583
CrossRef11
D. J. Bihm, A. Ettinger, K. A. Buytaert-Hoefen, B. K. Hendrix, G. Maldonado-Codina, G. Rock, P. C. Giclas, R. P. Goodrich. (2010) Characterization of plasma protein activity in riboflavin and UV light-treated fresh frozen plasma during 2 years of storage at â30°C. Vox Sanguinis 98:2, 108-115
CrossRef12
Mireille Hontebeyrie, Simone Frédérique Brenière, Christine Aznar. 2010. Other Forms of Transmission. , 583-597.
CrossRef13
Marcie Tomblyn, Tom Chiller, Hermann Einsele, Ronald Gress, Kent Sepkowitz, Jan Storek, John R. Wingard, Jo-Anne H. Young, Michael A. Boeckh. (2009) Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective. Biology of Blood and Marrow Transplantation 15:10, 1143-1238
CrossRef14
(2009) References. Bone Marrow Transplantation 44:8, 537-557
CrossRef15
E. Castro. (2009) Chagas’ disease: lessons from routine donation testing. Transfusion Medicine 19:1, 16-23
CrossRef16
Caryn Bern, Susan P Montgomery, Louis Katz, Sally Caglioti, Susan L Stramer. (2008) Chagas disease and the US blood supply. Current Opinion in Infectious Diseases 21:5, 476-482
CrossRef17
Sheila F. O'Brien, Jo Anne Chiavetta, Wenli Fan, Guoliang Xi, Qi-Long Yi, Mindy Goldman, Vito Scalia, Margaret A. Fearon. (2008) Assessment of a travel question to identify donors with risk of Trypanosoma cruzi: operational validity and field testing. Transfusion 48:4, 755-761
CrossRef18
Heather L. Reddy, Anthony D. Dayan, Joy Cavagnaro, Shayne Gad, Junzhi Li, Raymond P. Goodrich. (2008) Toxicity Testing of a Novel Riboflavin-Based Technology for Pathogen Reduction and White Blood Cell Inactivation. Transfusion Medicine Reviews 22:2, 133-153
CrossRef19
Roger Y Dodd. (2008) Current risk for transfusion transmitted infections. Current Opinion in Internal Medicine 7:1, 45-50
CrossRef20
Louis V. Kirchhoff, Richard D. Pearson. (2007) The emergence of Chagas disease in the United States and Canada. Current Infectious Disease Reports 9:5, 347-350
CrossRef21
G. A. Schmunis. (2007) The globalization of Chagas disease. ISBT Science Series 2:1, 6-11
CrossRef22
Carolyn Young, Phyllis Losikoff, Anjulika Chawla, Lewis Glasser, Edwin Forman. (2007) Transfusion-acquired Trypanosoma cruzi infection. Transfusion 47:3, 540-544
CrossRef23
A. Skripchenko, A. Balch, A. Mackin, S. J. Wagner. (2007) In vivo recovery and survival of red cells after photodynamic treatment with thiopyrylium and red light using a canine model. Vox Sanguinis 92:2, 157-159
CrossRef24
Leslie H. Tobler, Paul Contestable, Lubor Pitina, Holly Groth, Shirley Shaffer, Gary R. Blackburn, Harold Warren, Stephen R. Lee, Michael P. Busch. (2007) Evaluation of a new enzyme-linked immunosorbent assay for detection of Chagas antibody in US blood donors. Transfusion 47:1, 90-96
CrossRef25
M. Berrizbeitia, M. Ndao, J. Bubis, M. Gottschalk, A. Aché, S. Lacouture, M. Medina, B. J. Ward. (2006) Field evaluation of four novel enzyme immunoassays for Chagas' disease in Venezuela blood banks: comparison of assays using fixed-epimastigotes, fixed-trypomastigotes or trypomastigote excreted?secreted antigens from two Trypanosoma cruzi strains. Transfusion Medicine 16:6, 419-431
CrossRef26
Chi-Deu Chang, Kevin Y. Cheng, Lily X. Jiang, Vince A. Salbilla, Alla S. Haller, Alex W. Yem, Jane D. Bryant, Louis V. Kirchhoff, David A. Leiby, Gerald Schochetman, Dinesh O. Shah. (2006) Evaluation of a prototype Trypanosoma cruzi antibody assay with recombinant antigens on a fully automated chemiluminescence analyzer for blood donor screening. Transfusion 46:10, 1737-1744
CrossRef27
Louis V. Kirchhoff, Patricia Paredes, Abel Lomelí-Guerrero, Mario Paredes-Espinoza, Carlos S. Ron-Guerrero, Manuel Delgado-Mejía, José G. Peña-Muñoz. (2006) Transfusion-associated Chagas disease (American trypanosomiasis) in Mexico: implications for transfusion medicine in the United States. Transfusion 46:2, 298-304
CrossRef28
Stephen J. Wagner, Andrey Skripchenko, David J. Donnelly, Krishna Ramaswamy, Michael R. Detty. (2005) Chalcogenoxanthylium photosensitizers for the photodynamic purging of blood-borne viral and bacterial pathogens. Bioorganic & Medicinal Chemistry 13:21, 5927-5935
CrossRef29
A J. G. Jansen, D J. van Rhenen, E A. P. Steegers, J J. Duvekot. (2005) Postpartum Hemorrhage and Transfusion of Blood and Blood Components. Obstetrical & Gynecological Survey 60:10, 663-671
CrossRef30
Stephen J. Wagner, Andrey Skripchenko, Louis Cincotta, Dedeene Thompson-Montgomery, Helen Awatefe. (2005) Use of a flexible thiopyrylium photosensitizer and competitive inhibitor for pathogen reduction of viruses and bacteria with retention of red cell storage properties. Transfusion 45:5, 752-760
CrossRef31
Jean Pierre Allain, Celso Bianco, Morris A. Blajchman, Mark E. Brecher, Michael Busch, David Leiby, Lily Lin, Susan Stramer. (2005) Protecting the Blood Supply From Emerging Pathogens: The Role of Pathogen Inactivation. Transfusion Medicine Reviews 19:2, 110-126
CrossRef32
Roger Y. Dodd. (2004) Current Safety of the Blood Supply in the United States. International Journal of Hematology 80:4, 301-305
CrossRef33
Roger Y. Dodd, David A. Leiby. (2004) Emerging Infectious Threats to the Blood Supply. Annual Review of Medicine 55:1, 191-207
CrossRef34
Louis V. Kirchhoff. (2003) Changing epidemiology and approaches to therapy for Chagas disease. Current Infectious Disease Reports 5:1, 59-65
CrossRef35
David A. Leiby, Ross M. Herron, Elizabeth J. Read, Bruce A. Lenes, Robert J. Stumpf. (2002) Trypanosoma cruzi in Los Angeles and Miami blood donors: impact of evolving donor demographics on seroprevalence and implications for transfusion transmission. Transfusion 42:5, 549-555
CrossRef
