Transfusion-Transmitted Parasitic Diseases

7/31/2019 Transfusion-Transmitted Parasitic Diseases

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Recipient has evidence of infection post-

transfusion

No evidence of infection prior to transfusion No evidence of an alternative source of

infection


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Malaria

Babesiosis

Leishmaniasis

Chagas' disease

Toxoplasmosis

Filariasis


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Asymptomatic parasitemic individual

qualifies as a blood donor

The ability of the parasite to survive in

stored donated blood

Infected blood is transfused in a sufficientdose to a susceptible patient

Immune status of the recipient


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.is the most common parasitic infection

implicated in transfusion-transmitted infections. . is a mosquito-borne infectious disease

. is caused by intraerythrocytic protozoa of

the genus Plasmodium.

Plasmodium falciparum is the most common,

followed by P. vivax, P. malariae, P. ovale


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Pre-erthrocytic phase of the life

cycle within the liver does not occur

Incubation period is shorter (2

4 days asthe inoculum contains the erythrocytic

forms of the parasite)

Exo-erythrocytic schizogony is not seen Relapses do not occur

Radical cure is possible


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Blood components

Most cases were linked to RBCs Some cases were linked to cryoprecipitated

antihemophilic factor , platelets or white cell

concentrates (because of contamination with

residual red cells) Parasites can survive for 3 weeks in

refrigerated blood and in frozen blood.

Single parasite identified on microscopicevaluation of a thick blood film (4 L) is

equivalent to ~10,000 parasites in a 450-mL

blood unit.


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In nonendemic countries as United States,it is very low (1 case per 4 million)

In the endemic countries, it is much higher

(>50 cases per million donor units) .

Immune-compromised recipients Children under ages less than five years

Pregnant women.


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The first case of transfusion malaria was

reported in 1911TTM have been reported in a number of

countries; Canada , France , Italy, Brazil,

United States, Korea ,United Kingdom .

The reported incidence of TTM increased

from 6 to 145 cases per year.

The median prevalence of malaria amongblood donors was 10.2% (range, 0.7% in

Kenya to 55.0% in Nigeria).


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. is a tickborne infectious disease

. . . is caused by intraerythrocytic

protozoa of the genus Babesia

. . . also, is transmitted by transfusionMost human infections have been

acquired in temperate regions of the

United States and Europe.


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Etiologic agents Most cases were caused by B. microti

Several were caused by B. duncani, (the

WA1-type parasite)

Blood components Most cases were linked to RBCs

Several were linked toplatelets

Incubation period: (6-9 weeks) compared with1-4 weeks in naturally acquired illness.

The parasites can remain viable under blood

bank conditions, at 4C for up to 35 days


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-Unrecognized, protracted infection in some donors

Donor travel to & from foci of endemicity

Intraregional distribution & interregional shipment of blood

Translate into the potential for

Transmission by transfusionany time (year-round)

any where


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The first case of TTB was reported in 1980

from Boston, and involved the transmission of

B. microti to a 70-year-old patient after the

transfusion of 20 platelet units.

The incidence of reported TTB was 1.1 casesper million RBC units.

Seroprevalence of Babesia antibodies in

asymptomatic blood donors range from 1.1%in US to 8% in Germany.


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. is a vector-borne parasitic disease.

. is caused by obligate intracellular protozoan

of the genus Leishmania.

. is naturally transmitted by the bite of

phlebotomine sandflies

. also, is transmitted by

Blood transfusion Sexual intercourse

Laboratory acquired infections

Congenitally


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The most severe form of the disease, that caused

by the Leishmaniadonovani complex

The disease starts with an asymptomatic

subclinical period in which parasites (amastigote

forms) may be circulating in the peripheral blood

within large mononuclear cells and

polymorphonuclear leukocytes


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The parasitaemic individuals usually have

a very low parasite density and may serve

as a source of TTL The duration of asymptomatic

parasitaemia varies from 1-14 months

L. donovani can survive for 30 days in

unprocessed whole blood left at 4C.


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Literature search showed only 11 reports of

transfusion-transmitted leishmaniasis. Of these, 10 were individual case reports from

Asia and Europe and in one paper from Brazil 32

cases were reported out of 82 patients

undergoing hemodialysis.

The mean incubation period between thetransfusion of the Leishmaniainfected blood and

first clinical manifestation was 7.4 months


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The prevalence of anti-Leishmaniaantibodies

in blood donors ranged from 0.75% in Italy to

10.7% in Brazil by using IFAT

The detection of LeishmaniaDNA among

blood donors ranged from 22.1% in Spanish

endemic area to 36.4% in Italy by PCR


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.is caused by the flagellateprotozoan, Trypanosoma

cruzi.

. is widespread in Latin

America

about 18 million people were

found to be infected

and 90 million people at

risk.


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The natural infection is transmitted by the contact of

broken human skin with metacyclic trypomastigotes

present in contaminated feces of blood-sucking triatomine

insect (reduviid bug).

Blood transfusion

Via the placenta or by breast-feeding to newborn infants

Organ transplantation

Laboratory accidents

Ingestion of contaminated food


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The parasite can remain viable at 4C in

Stored whole blood 7 days

Platelets 4 days

Frozen plasma components 24 hours.

The incubation period of acute Chagas' disease

following an infected blood unit varies from 20 to

40 days


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The first two cases of TT-CD were reported

in 1952 in Sao Paulo, Brazil. About 10,000 new cases of T. cruzi infection

occurred per year in Brazil throughtransfusional transmission

In United States and Canada; a few cases ofinfection mediated by transfusion have beendocumented all occurred inimmunocompromised recipients

Seropositive blood donors ranged from

12% - 48% in endemic areas

13%23% in nonendemic areas


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. is an opportunistic infection

.caused by the obligate intracellularcoccidian protozoa; Toxoplasma gondii.

Worldwide in distribution

. is transmitted by

Ingestion of tissue cysts in raw or undercooked

infected meat

Ingestion of food or water contaminated with

sporulated oocysts shed in the feces of an infectedcat.

Blood transfusion

Organ transplantation

Congenitally


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T. gondiiis found in the blood during the phase

of parasitemia early in

the acute phase of

infection and also in

reactivated disseminated

cases

T. gondii can survive in citrated whole blood for

up to 50 days at 4 C, thus refrigeration of blood

units during storage cannot prevent transmission


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TTT can result in significant clinical

consequences in immunocompromised, pregnantwomen, fetus.

Toxoplasma seroprevalence in blood donors

varies from a low of 4.1% in Thailand to 75% in

Brazil


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.. is caused by thread-like nematodes

. is transmitted by blood-feeding arthropods,

including mosquitoes.

Sexually mature female worms release

microfilariae into the bloodstream.

Microfilaria may survive in refrigerated bloodunits for 2-3 weeks.
http://en.wikipedia.org/wiki/Nematodehttp://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Mosquitohttp://en.wikipedia.org/wiki/Arthropodhttp://en.wikipedia.org/wiki/Nematode


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Transfusion-transmitted microfilaremia is self limited

because transfused microfilariae do not develop intoadult filarial worms.

The recipients may usually develop post transfusion

allergic reactions to dying microfilariae.

Adult worm may be present in blood collected from an

asymptomatic blood donor but, it cannot pass through

routine blood transfusion.


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The first case of transfusional filariasis in a

nonendemic area by Weller et al.(1978), who

reported on tourism-acquired Mansonella

ozzardimicrofilaraemia from a blood donor.

Bregani et al., (2003) describe a case of post-

transfusional M. perstans microfilariasis in an

infant from Chad.


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In India filarial antibody was detected in

55.3% of blood donors but microfilaria was

detected in 8.5%.

Nigerian blood donors showed prevalence of

1.3% Loa loa, 15.6% M. perstans, and 0.2%

coinfection of both parasites


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Screening of donated blood by microscopic

examination is not a sensitive tool as

parasitemia in immunocompetentindividuals is too low to be detected.

Screening of donor blood samples were

performed through immunological methods Immuno-fluorescence antibody test (IFAT)

Enzyme immunoassays

Western blotting Radioimmuneprecipitation assay

RDTs


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In subclinical infections the antibody levels are

low and serological tests show low sensitivity.

PCR has been proved to be the most sensitive and

specific technique to detect parasite DNA in the

peripheral blood of asymptomatic blood donors

Molecular screening should be carried out on the

blood being transfused to immuno-compromised

patients, pregnant women and in intrauterine and

neonatal transfusion


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Serological screening of donated blood

Antiparasitic should be added to donatedblood to eradicate parasites in vitro

Leukoreduction by filtration of donated

blood. This method effective for intra-cytoplasmatic pathogen but, ineffective for

intraerythrocytic agents

Pathogen inactivation; chemical treatment

of blood with crystal violet, amotosalen and

ultraviolet light or riboflavin and ultraviolet

light


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Transfusion-Transmitted Parasitic Diseases