Across state lines: Fulminant <i>Babesia microti</i> infection in a liver transplant recipient

Meissner, Eric G.; McGillicuddy, John W.; Squires, Jerry E.; Skipper, D.; Self, Sally; Wray, Dannah; Moritz, Erin D.; Stramer, Susan L.; Nadig, Satish N.

doi:10.1111/tid.12741

Cited by 9 publications

(6 citation statements)

References 9 publications

(16 reference statements)

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“…Exceptions were two donors from non‐endemic states (California and Georgia) who traveled back home after vacationing in Massachusetts and Maine, and one donor from North Carolina without relevant recent travel history. The North Carolina donor's weak testing results (PCR negative, AFIA 1:64) suggest that the second positive donor identified during the investigation, a Minnesota resident who was PCR and AFIA positive (1:512) for B. microti , was likely responsible for the transmission in this case . Babesiosis is not a reportable disease in North Carolina and no cases have been reported in the state.…”

Section: Discussionmentioning

confidence: 82%

“…Most donors (78, 97%) were residents of the northeastern and upper midwestern United States, known to be endemic for B. microti . One exception was a donor who resided in North Carolina, identified in a case involving two positive donors (Table ; one donor from North Carolina and the second from Minnesota) . Two additional cases, not shown on the maps, are from donors residing in Georgia and California who donated in their state of residence after traveling to Maine and Massachusetts, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Characteristics of transfusion‐transmitted Babesia microti, American Red Cross 2010‐2017

et al. 2019

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BACKGROUND Babesia microti, a red blood cell (RBC) parasite transmitted naturally to vertebrate hosts by ixodid ticks, is endemic to the northeastern and upper midwestern United States, with the geographic range of infected ticks expanding. B. microti is a blood safety issue with >200 transfusion‐transmissions reported. METHODS The American Red Cross's Hemovigilance program investigated hospital‐reported transfusion‐transmitted babesiosis (TTB) cases. Follow‐up samples from involved donors were tested for B. microti antibodies and parasite DNA, the latter by real‐time polymerase chain reaction (PCR). Test‐positive donors were permanently deferred from future donations. RESULTS B. microti‐positive donors were implicated in 77 of 143 suspect TTB cases investigated from 2010 through 2017. In four cases, two positive donors were identified for a total of 81 positive donors. In three cases, a RBC unit was split and components transfused multiple times to the same pediatric recipient. RBCs were the transmitting product in all cases. At follow‐up, all involved donors were antibody positive; 25 donors were also PCR positive. Positive donations were collected throughout the year, peaking in the summer. Most donors (78) were resident of, or traveled to (2), an endemic state. One donor resided in a non‐endemic state without relevant travel history. One fatality listed babesia as a contributing factor. No implicated donation was screened by an investigational protocol. CONCLUSIONS Babesiosis remains a blood safety issue. Prior to FDA‐licensed screening test availability and final FDA Guidance, blood collectors in endemic states investigationally tested none, a portion, or all collections. Future expanded testing will reduce the frequency of TTB cases.

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Section: Discussionmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Characteristics of transfusion‐transmitted Babesia microti, American Red Cross 2010‐2017

et al. 2019

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“…TTB is also not geographically bound, given that blood donors from non-endemic areas may travel to endemic areas where they can acquire the infection through tick bite, return to the non-endemic area and donate infectious blood. Finally, blood that is collected in endemic states is frequently shipped to states that are not considered high risk for babesiosis, also accounting for cases of TTB in non-endemic states [47,48,49].…”

Section: Persistent Babesia Microti Infection In Asymptomatic Immumentioning

confidence: 99%

Persistence of Babesia microti Infection in Humans

2019

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Persistent infection is a characteristic feature of babesiosis, a worldwide, emerging tick-borne disease caused by members of the genus Babesia. Persistence of Babesia infection in reservoir hosts increases the probability of survival and transmission of these pathogens. Laboratory tools to detect Babesia in red blood cells include microscopic detection using peripheral blood smears, nucleic acid detection (polymerase chain reaction and transcription mediated amplification), antigen detection, and antibody detection. Babesia microti, the major cause of human babesiosis, can asymptomatically infect immunocompetent individuals for up to two years. Chronically infected blood donors may transmit the pathogen to another person through blood transfusion. Transfusion-transmitted babesiosis causes severe complications and death in about a fifth of cases. Immunocompromised patients, including those with asplenia, HIV/AIDS, malignancy, or on immunosuppressive drugs, often experience severe disease that may relapse up to two years later despite anti-Babesia therapy. Persistent Babesia infection is promoted by Babesia immune evasive strategies and impaired host immune mechanisms. The health burden of persistent and recrudescent babesiosis can be minimized by development of novel therapeutic measures, such as new anti-parasitic drugs or drug combinations, improved anti-parasitic drug duration strategies, or immunoglobulin preparations; and novel preventive approaches, including early detection methods, tick-avoidance, and blood donor screening.

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“…Two additional cases of infection in patients who received transfusions in nonendemic areas have recently been reported to the blood collection agency. Case 5 is a man who underwent liver transplantation, received a transfusion in South Carolina, and developed severe clinical babesiosis . Case 6 is a woman with ovarian cancer who received a transfusion in Nebraska with a RBC unit collected from a donor who later screened positive for B. microti ; the recipient in Case 6 did not develop clinical symptoms of babesiosis.…”

Section: Discussionmentioning

confidence: 99%

Cases of transfusion‐transmitted babesiosis occurring in nonendemic areas: a diagnostic dilemma

et al. 2017

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Across state lines: Fulminant Babesia microti infection in a liver transplant recipient

Cited by 9 publications

References 9 publications

Characteristics of transfusion‐transmitted Babesia microti, American Red Cross 2010‐2017

Characteristics of transfusion‐transmitted Babesia microti, American Red Cross 2010‐2017

Persistence of Babesia microti Infection in Humans

Cases of transfusion‐transmitted babesiosis occurring in nonendemic areas: a diagnostic dilemma

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