Transfusion‐transmitted leishmaniasis: a practical review

Abstract

In the Balearic Islands, as in other areas in southern Europe, there are a significant proportion of asymptomatic Leishmania infantum-infected blood donors. Theoretically, these donors may represent an important challenge for blood transfusion safety. However, despite an active search of multiply transfused patients, there have been, so far, no cases of transfusion-transmitted leishmaniasis (TTL) in our region. On the other hand, there is scarce evidence of the TTL in the literature. A review of asymptomatic Leishmania-infected blood donors' studies in endemic areas and TTL reports published in the English literature were performed, to ascertain the factors that determine the real risk of transfusion transmission of Leishmania.

Asymptomatic Leishmania infantum infection in blood donors living in an endemic area, northeastern Italy

“…However, pre-storage leukodepletion, which is mandatory in Italy since January 2016, is greatly effective in reducing the risk of Leishmania transmission by parasitemic blood donors. 24 Strategies that reduce live parasites in blood supplies are under study and should be taken into consideration in endemic areas. Several methods for inactivation of Leishmania parasites such as riboflavin and ultraviolet light, 25 amatosalen and UVA illumination, 26 and thiazole orange 27 have been shown to be effective when applied to different blood components in in vitro studies.…”

Our experience in riboflavin and ultraviolet light pathogen reduction technology for platelets: from platelet production to patient care

“…Despite progress in donor screening and laboratory testing, a small risk of bacterial, viral, or protozoal contamination of PLTs persists. There is also a continuous risk from newly emerging blood transfusion–transmitted infectious agents .…”

“…11 As previously demonstrated by our research group, the application of methods against transfusion-transmitted leishmaniasis (TTL), such as leukoreduction for red blood cells (RBCs) and riboflavin and ultraviolet (UV) light PRT for PLTs, have contributed substantially to the prevention of transfusion-transmitted leishmaniasis cases in the Balearic Islands. [12][13][14] T. cruzi is a representative example of an emerging pathogen that is gaining importance in nonendemic countries, where the main transmission route is via blood transfusion. No longer confined to Latin America, the disease has become an important blood safety threat for countries like Spain, which is a popular destination for Latin American migrants.…”

Leishmania spp. seropositivity in Austrian soldiers returning from the Kosovo

“…In endemic countries such as Spain, high Leishmania seroprevalence rates among blood donors are reported and measures to prevent TTL, such as leukoreduction, have been implemented. Regular blood donation of military personnel with subclinical infections could pose a risk for an increased but unrecognized introduction of TTL infections, which particularly pose a risk for immunocompromized recipients of blood transfusions such as organ transplant recipients or cancer patients [15][16][17]. The U.S. Department of Defense and the American Association of Blood Banks (AABB) banned all U.S. soldiers who had served in Iraq from blood donation for 1 year [18].…”