Septic shock due to visceral leishmaniasis, probably transmitted from blood transfusion

Abstract

A case of visceral leishmaniasis (VL) in a 77-year-old woman, with renal failure on haemodialysis, admitted in the intensive care unit (ICU) with vascular instability requiring vassopressor treatment, is presented. Initially, no co-infection could be detected. The patient initially responded well when liposomal amphotericin B was administered, after bone marrow demonstrated multiple intra-cellular Leishmania amastigotes and extra-cellular promastigotes. However, the patient died from uncontrolled septic shock from a secondary bacterial infection, the tenth day of admission. To our knowledge, vascular instability has not been reported in VL. Moreover, non-vector transmission was also suspected in this case. The patient had undergone cholecystectomy three months earlier, during which two blood units had been transfused; IgG anti-Leishmania antibodies at a high titer were detected in one of the two healthy blood donors, later.

Transfusion‐transmitted visceral leishmaniasis caused by Leishmania (Leishmania) mexicana in an immunocompromised patient: a case report

“…VL is a known opportunistic infection most commonly affecting immunosuppressed individuals, especially HIV patients 12 and less frequently organ transplant recipients 13‐15 . Three possible mechanisms may be responsible for the clinical development of VL: 1) acquisition of Leishmania infection via the bite of an infected sand fly, 16 2) reactivation of a latent infection induced by immunosuppression or acquired immunodeficiency, 17,18 and 3) iatrogenic acquisition of Leishmania infection directly through the transplanted organ or after transfusion of infected blood products 13‐15,19,20 . According to the answers given during the interview, the patient apparently always lived in urban areas considered as nonendemic for leishmaniasis and never had leishmaniasis.…”

Serological survey of Leishmaniainfection in blood donors in Salvador, Northeastern Brazil

“…Classically, transmission of Leishmania parasites occurs through sand fly bites, however, studies in France {[7] #248}, Italy {[8] #6}, Spain {[9] #12}, India {[10] #9}, Bangladesh {[11] #250} and Turkey {[12] #251} showed that asymptomatic individuals are found among blood donors, suggesting that transfusion of Leishmania -contaminated blood products might be a source of disease transmission in parallel to syringe sharing {[13] #68} and organ transplantation {[14] #7; [15] #8; [16] #19; [17] #41; [18] #246}. In northeastern Brazil, the prevalence of anti- Leishmania antibodies was 9% among blood donors, increased to 25% in a VL focus and was highest (37%) among poly-transfused hemodialysis patients {[19] #37}.…”

Reduction of Leishmania donovani infectivity in whole blood using riboflavin and ultraviolet light

“…Transmission of the Leishmania parasite through blood transfusion has not been reported in the United States. However, cases of transfusion‐transmitted L. donovani have been described in several countries . Most of the reports occurred before 1997 and do not contain specific manufacturing details about the transfused blood, but it is unlikely that the blood was leukoreduced.…”