Investigation of transfusion transmission of a WA1‐type babesial parasite to a premature infant in California

Abstract

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.

Comparison of the Babesia duncani (WA1) IgG Detection Rates among Clinical Sera Submitted to a Reference Laboratory for WA1 IgG Testing and Blood Donor Specimens from Diverse Geographic Areas of the United States

“…In serologic investigations, titers of WA1 IgG were markedly elevated (Ն1:5,120) in convalescent-phase sera from all patients and in sera from the asymptomatic blood donors implicated in transfusion-transmitted cases (4,9,13). Consistent with the phylogenetic data, antibodies induced by WA1 infection did not cross-react with B. microti.…”

“…Without such data, it is difficult to interpret some of our findings. For example, the female predominance among WA1 IgG-positive patients stands in stark contrast to the observation that all 9 documented WA1 cases occurred in males (4,9,13,15) and to the male predominance observed for tick-borne infections in general (3,16,17,18). Similarly, the lack of a seasonal increase in WA1 IgG detection during North American summer months is atypical for a tick-borne infection (14).…”

“…An additional 8 cases of WA1 infection have been described in the medical literature (4,9,13), all in males residing in Washington or California; two of these cases reflected transmission by transfusion of infected blood products from an asymptomatic donor. In serologic investigations, titers of WA1 IgG were markedly elevated (Ն1:5,120) in convalescent-phase sera from all patients and in sera from the asymptomatic blood donors implicated in transfusion-transmitted cases (4,9,13).…”

Babesiosis Acquired through Blood Transfusion, California, USA

“…Available screening tests to detect Babesia spp. postdonation are not cost-effective and have inadequate sensitivity (7,10). Nucleic acid testing and inactivation procedures may provide useful options for detecting Babesia spp.…”

A cluster of transfusion-associated babesiosis in extremely low birthweight premature infants

“…2 Babesiosis may also be transmitted by transfusion of blood products and rarely transplacentally. [3][4][5][6] The cases of neonates with transfusionassociated infections have been reported [7][8][9][10][11][12] primarily in areas endemic for babesiosis. Here, we report a series of three cases of transfusion-associated babesiosis in preterm infants hospitalized in a non-endemic region for Babesia who had a protracted course and therapy, well beyond prior published recommendations and reported clinical experience.…”