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Pereira LQ, Tanaka SCSV, Ferreira-Silva MM, Gomes FVBAF, Santana MP, Aguiar PR, de Araújo Pereira G, Gómez-Hernández C, Junior VR, De Vito FB, Moraes-Souza H. Leukoreduction as a control measure in transfusion transmission of visceral leishmaniasis. Transfusion 2023; 63:1044-1049. [PMID: 36929836 DOI: 10.1111/trf.17308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Asymptomatic visceral leishmaniasis (VL) infection is a risk for transfusion safety. Leukoreduction has been an alternative for the prevention of some blood-borne diseases, including VL. This study aimed to evaluate the role of leukoreduction of cellular blood components as a control measure for transfusional VL transmission. RESEARCH DESIGN AND METHODS A total of 161 polytransfused patients with non-leukoreduced blood components (HNL), 95 polytransfused with leukoreduced blood components (LH), and 202 non-transfused (NT) from endemic regions for VL and with a similar epidemiological profile. The detection of antibodies against VL was performed by ELISA and the presence of the parasite was investigated by real-time PCR. Statistical significance was defined as p < .05. RESULTS When comparing three groups, ELISA results were statistically significant (p = .0065). The residual analysis of ELISA showed statistically significant for the HNL group compared to the general group (p = .002; OR: 5.6; CI: 1.7-25.8), demonstrating that individuals who received non-leukoreduced transfusions are five times more likely to acquire Leishmania infantum infection than the general. DISCUSSION Higher prevalence in the group with HNL and low prevalence in those who received LH, similar to NT patients, highlight the risk of transfusional VL transmission and reinforce the role of leukoreduction in its prevention.
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Affiliation(s)
- Loren Queli Pereira
- Laboratory of Hematological Research, Triângulo Mineiro Federal University, Uberaba, Brazil
| | | | | | | | - Melissa Palis Santana
- Government of Piauí, Hemopi - Hematology and Hemotherapy Center of the State of Piauí, Teresina, Brazil
| | - Paulo Roberto Aguiar
- Hemominas Foundation, Regional Blood Center of Montes Claros (Minas Gerais), Montes Claros, Brazil
| | - Gilberto de Araújo Pereira
- Department of Nursing in Education and Community Health, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | | | - Helio Moraes-Souza
- Laboratory of Hematological Research, Triângulo Mineiro Federal University, Uberaba, Brazil
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Gómez LA, Gutierrez FRS, Peñuela OA. Trypanosoma cruzi infection in transfusion medicine. Hematol Transfus Cell Ther 2019; 41:262-267. [PMID: 31085149 PMCID: PMC6732405 DOI: 10.1016/j.htct.2018.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/19/2018] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Infection by Trypanosoma cruzi is challenging to blood bank supplies in terms of accurate diagnosis, mostly due to its clinical complexity. Infected individuals may remain asymptomatic for years, albeit they may have circulating parasites potentially transferable to eventual receptors of a transfusion. OBJECTIVE Although risk donors are systematically excluded through a survey, an important residual risk for transmission remains, evidencing the need to implement additional actions for the detection of T. cruzi in blood banks. METHOD A review of the scientific literature is presented with the objective of identifying relevant publications on this subject. RESULTS We discuss the diagnostic considerations of this chronic infection on transfusion medicine and some recent advances in the processing of blood and derivatives units. CONCLUSION Finally, recommendations are made on how the transmission of T. cruzi can be avoided through the implementation of better diagnostic and pathogen control measures at blood banks.
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Affiliation(s)
- Lina Andrea Gómez
- Biomedical Research Center (CIBUS), School of Medicine, Universidad de la Sabana, Chía, Colombia.
| | - Fredy R S Gutierrez
- Laboratory of Immunology, School of Medicine, Antonio Nariño University, Bogotá, Colombia
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Sayama Y, Furui Y, Takakura A, Ishinoda M, Matsumoto C, Taira R, Igarashi S, Momose S, Matsubayashi K, Uchida S, Hino S, Nagai T, Satake M. Seroprevalence of Trypanosoma cruzi infection among at-risk blood donors in Japan. Transfusion 2018; 59:287-294. [PMID: 30474861 DOI: 10.1111/trf.14999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chagas disease is caused by Trypanosoma cruzi and is endemic in Latin America. In nonendemic countries, including Japan, Chagas disease is primarily a problem in the context of transfusion transmission. Approximately 250,000 immigrants from Latin America reside in Japan, and many of those individuals serve as active blood donors. This study surveyed the seroprevalence of T. cruzi infection among at-risk blood donors in Japan, defined as those who themselves (or whose mothers) were born (or raised) in Latin America, or those with a travel history to Latin America. STUDY DESIGN AND METHODS Blood samples were obtained from at-risk donors in two periods, 2004-2012 and 2013-2016. Collected samples were tested for T. cruzi antibodies using both an enzyme-linked immunosorbent assay and a chemiluminescent immunoassay. Samples that tested positive in both assays were additionally tested by polymerase chain reaction, and look-back investigation was conducted when necessary. RESULTS Of 18,484 samples obtained from 18,076 at-risk donors, 3 (1:6,025, 0.017%) donors showed seroreactivity by enzyme-linked immunosorbent assay and chemiluminescent immunoassay. All antibody-positive donors were born in Latin America. One of them also was positive for T. cruzi DNA. Eleven previous donations from this donor were subjected to look-back investigation, and five recipients were tested. All five recipients tested negative for T. cruzi antibodies. CONCLUSION Seroprevalence of T. cruzi was 0.017% among at-risk donors in Japan. Transfusion-transmitted infection of Chagas disease has not been confirmed to date. Screening for T. cruzi antibodies by targeting at-risk donors is an appropriate strategy for ensuring blood safety in Japan.
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Affiliation(s)
- Yusuke Sayama
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Yasumi Furui
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Akiko Takakura
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masazumi Ishinoda
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Chieko Matsumoto
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Rikizo Taira
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Shigeru Igarashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Shun'ya Momose
- Japanese Red Cross Kinki Block Blood Center, Osaka, Japan
| | - Keiji Matsubayashi
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Shigeharu Uchida
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Satoru Hino
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Tadashi Nagai
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan.,Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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Jimenez-Marco T, Cancino-Faure B, Girona-Llobera E, Alcover MM, Riera C, Fisa R. The effectiveness of riboflavin and ultraviolet light pathogen reduction technology in eliminatingTrypanosoma cruzifrom leukoreduced whole blood. Transfusion 2017; 57:1440-1447. [DOI: 10.1111/trf.14071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Teresa Jimenez-Marco
- Fundació Banc de Sang i Teixits de las Illes Balears; Majorca
- IUNICS Institut Universitari d' Investigació en Ciències de la Salut, Universitat de les Illes Balears; Majorca
| | - Beatriz Cancino-Faure
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació; Universitat de Barcelona; Barcelona Spain
| | - Enrique Girona-Llobera
- Fundació Banc de Sang i Teixits de las Illes Balears; Majorca
- IUNICS Institut Universitari d' Investigació en Ciències de la Salut, Universitat de les Illes Balears; Majorca
| | - M. Magdalena Alcover
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació; Universitat de Barcelona; Barcelona Spain
| | - Cristina Riera
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació; Universitat de Barcelona; Barcelona Spain
| | - Roser Fisa
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de Farmàcia i Ciències de l'Alimentació; Universitat de Barcelona; Barcelona Spain
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Chagas disease and transfusion medicine: a perspective from non-endemic countries. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 13:540-50. [PMID: 26513769 DOI: 10.2450/2015.0040-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 06/18/2015] [Indexed: 11/21/2022]
Abstract
In the last decades, increasing international migration and travel from Latin America to Europe have favoured the emergence of tropical diseases outside their "historical" boundaries. Chagas disease, a zoonosis endemic in rural areas of Central and South America represents a clear example of this phenomenon. In the absence of the vector, one of the potential modes of transmission of Chagas disease in non-endemic regions is through blood and blood products. As most patients with Chagas disease are asymptomatic and unaware of their condition, in case of blood donation they can inadvertently represent a serious threat to the safety of the blood supply in non-endemic areas. Since the first cases of transfusion-transmitted Chagas disease were described in the last years, non-endemic countries began to develop ad hoc strategies to prevent and control the spread of the infection. United States, Spain, United Kingdom and France first recognised the need for Trypanosoma cruzi screening in at-risk blood donors. In this review, we trace an up-to-date perspective on Chagas disease, describing its peculiar features, from epidemiological, pathological, clinical and diagnostic points of view. Moreover, we describe the possible transmission of Chagas disease through blood or blood products and the current strategies for its control, focusing on non-endemic areas.
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Cancino‐Faure B, Fisa R, Riera C, Girona‐Llobera E, Jimenez‐Marco T. Where doTrypanosoma cruzigo? The distribution of parasites in blood components from fractionated infected whole blood. Transfusion 2016; 56:2233-8. [DOI: 10.1111/trf.13687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Beatriz Cancino‐Faure
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de FarmàciaUniversitat de BarcelonaBarcelona Catalonia, Spain
| | - Roser Fisa
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de FarmàciaUniversitat de BarcelonaBarcelona Catalonia, Spain
| | - Cristina Riera
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de FarmàciaUniversitat de BarcelonaBarcelona Catalonia, Spain
| | - Enrique Girona‐Llobera
- Fundació Banc de Sang i Teixits de las Illes Balears
- IUNICS Institut Universitari d' Investigació en Ciències de la Salut, Universitat de les Illes BalearsMajorca Balearic Islands Spain
| | - Teresa Jimenez‐Marco
- Fundació Banc de Sang i Teixits de las Illes Balears
- IUNICS Institut Universitari d' Investigació en Ciències de la Salut, Universitat de les Illes BalearsMajorca Balearic Islands Spain
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Slot E, Hogema BM, Molier M, Bart A, Zaaijer HL. Risk Factors and Screening for Trypanosoma cruzi Infection of Dutch Blood Donors. PLoS One 2016; 11:e0151038. [PMID: 26950434 PMCID: PMC4780700 DOI: 10.1371/journal.pone.0151038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Blood donors unaware of Trypanosoma cruzi infection may donate infectious blood. Risk factors and the presence of T. cruzi antibodies in at-risk Dutch blood donors were studied to assess whether specific blood safety measures are warranted in the Netherlands. METHODOLOGY Birth in a country endemic for Chagas disease (CEC), having a mother born in a CEC, or having resided for at least six continuous months in a CEC were considered risk factors for T. cruzi infection. From March through September 2013, risk factor questions were asked to all donors who volunteered to donate blood or blood components. Serum samples were collected from donors reporting one or more risk factors, and screened for IgG antibodies to T. cruzi by EIA. RESULTS Risk factors for T. cruzi infection were reported by 1,426 of 227,278 donors (0.6%). Testing 1,333 at-risk donors, none (0.0%; 95%, CI 0.0-0.4%) was seroreactive for IgG antibodies to T. cruzi. A total of 472 donors were born in a CEC; 553 donors reported their mother being born in a CEC; and 1,121 donors reported a long-term stay in a CEC. The vast majority of reported risk factors were related to Suriname and Brazil. Overall, the participants resided for 7,694 years in CECs, which equals 2.8 million overnight stays. Of those, 1.9 million nights were spent in Suriname. CONCLUSIONS/SIGNIFICANCE Asymptomatic T. cruzi infection appears to be extremely rare among Dutch blood donors. Blood safety interventions to mitigate the risk of T. cruzi transmission by transfusion would be highly cost-ineffective in the Netherlands, and are thus not required.
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Affiliation(s)
- Ed Slot
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- * E-mail:
| | - Boris M. Hogema
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Virology, Sanquin Diagnostic Services, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Michel Molier
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Aldert Bart
- Department of Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
| | - Hans L. Zaaijer
- Department of Blood-borne Infections, Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Virology, Sanquin Diagnostic Services, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
- Department of Medical Microbiology (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
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Cancino-Faure B, Fisa R, Riera C, Bula I, Girona-Llobera E, Jimenez-Marco T. Evidence of meaningful levels ofTrypanosoma cruziin platelet concentrates from seropositive blood donors. Transfusion 2015; 55:1249-55. [DOI: 10.1111/trf.12989] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Beatriz Cancino-Faure
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Roser Fisa
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Cristina Riera
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Ibeth Bula
- Laboratori de Parasitologia, Departament de Microbiologia i Parasitologia Sanitàries, Facultat de Farmàcia; Universitat de Barcelona; Barcelona
| | - Enrique Girona-Llobera
- Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca; Balearic Islands
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS); Universitat de les Illes Balears, Mallorca; Balearic Islands Spain
| | - Teresa Jimenez-Marco
- Fundació Banc de Sang i Teixits de les Illes Balears, Mallorca; Balearic Islands
- Institut Universitari d' Investigació en Ciències de la Salut (IUNICS); Universitat de les Illes Balears, Mallorca; Balearic Islands Spain
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Proctor MC, Leiby DA. Do leukoreduction filters passively reduce the transmission risk of human granulocytic anaplasmosis? Transfusion 2014; 55:1242-8. [DOI: 10.1111/trf.12976] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Melanie C. Proctor
- Transmissible Diseases Department; American Red Cross Holland Laboratory; Rockville Maryland
| | - David A. Leiby
- Transmissible Diseases Department; American Red Cross Holland Laboratory; Rockville Maryland
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Abstract
Chagas disease, caused by the parasite Trypanosoma cruzi, is a major cause of morbidity and mortality in Central and South America. Initial infection and ensuing chronic infection often go undetected in the human host. High seroprevalence of T. cruzi infection is well documented in endemic areas. Designated as “a neglected tropical disease” by the World Health Organization, rural economically disadvantaged and marginalized populations in endemic countries traditionally have the highest rates of infection. As economic hardship, political instability, and the search for opportunity spur migration of infected humans from endemic to non-endemic areas of the world, blood bank data have documented rising seroprevalence of T. cruzi in traditionally nonendemic areas. In these areas, T. cruzi is transmitted through blood transfusion, organ transplantation, and maternal-fetal mechanisms. Increasing awareness of large numbers of infected immigrants in nonendemic countries, and the medical care they require, has focused attention on the need for strategic programs for screening affected populations, education of healthcare providers, and provision of necessary medical services for those infected. Physicians in nonendemic countries should be able to recognize signs and symptoms of acute and chronic Chagas disease as migration and globalization increase the burden of disease in non-endemic areas.
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Benjamin RJ, Stramer SL, Leiby DA, Dodd RY, Fearon M, Castro E. Trypanosoma cruzi infection in North America and Spain: evidence in support of transfusion transmission. Transfusion 2012; 52:1913-21; quiz 1912. [PMID: 22321142 DOI: 10.1111/j.1537-2995.2011.03554.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The United States, Canada, and Spain perform selective testing of blood donors for Trypanosoma cruzi infection (Chagas disease) to prevent transfusion transmission. The donor, product, and patient characteristics associated with transfusion-transmitted infections are reviewed and the infectivity of components from donors with serologic evidence of infection is estimated. STUDY DESIGN AND METHODS A systematic review of transfusion-transmitted T. cruzi cases and recipient tracing undertaken in North America and Spain is described. Cases were assessed for the imputability of the evidence for transfusion transmission. RESULTS T. cruzi infection in 20 transfusion recipients was linked to 18 serologically confirmed donors between 1987 and 2011, including 11 identified only by recipient tracing. Cases were geographically widely distributed and were not associated with incident or autochthonous infections. Index clinical cases were described only in immunocompromised patients. All definite transmissions (n = 11) implicated apheresis or whole blood-derived platelets (PLTs), including leukoreduced and irradiated products. There is no evidence of transmission by red blood cells (RBCs) or frozen products, while transmission by whole blood transfusion remains a possibility. Recipient tracing reveals low component infectivity from serologically confirmed, infected donors of 1.7% (95% confidence interval [CI], 0.7%-3.5%) overall: 13.3% (95% CI, 5.6%-25.7%) for PLTs, 0.0% (95% CI, 0.0%-1.5%) for RBCs, and 0.0% (95% CI, 0%-3.7%) for plasma and cryoprecipitate. CONCLUSIONS T. cruzi is transmitted by PLT components from some donors with serologic evidence of infection. Evidence of transmission before the implementation of widespread testing in the countries studied is sparse, and selective testing of only PLT and fresh whole blood donations should be considered.
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Affiliation(s)
- Richard J Benjamin
- American Red Cross Holland Laboratories, Rockville, Maryland 20855, USA.
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Wendel S. Transfusion transmitted Chagas disease: is it really under control? Acta Trop 2010; 115:28-34. [PMID: 20044970 DOI: 10.1016/j.actatropica.2009.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 12/12/2009] [Accepted: 12/22/2009] [Indexed: 12/13/2022]
Abstract
Transfusion transmitted Chagas disease was recognized as a medical problem more than 50 years ago. However, little attention was paid to it by Transfusion Medicine, medical authorities or regulatory agencies as a major problem and threat (especially after the advent of HIV/AIDS); perhaps because it was mainly restricted to tropical regions, usually in less developed countries. With the intense human migratory movement from developing to developed countries, it became more common and evident. The scope of this review is to cover the main transfusional aspects of American trypanosomiasis (Chagas disease), including the main strategies to prevent it through donor questionnaires, specific serological testing and alternative methods such as leukofiltration and pathogen reduction procedures, in order to increase the blood safety in both developing and developed countries.
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Bassuni WY, Blajchman MA, Al-Moshary MA. Why implement universal leukoreduction? Hematol Oncol Stem Cell Ther 2010; 1:106-23. [PMID: 20063539 DOI: 10.1016/s1658-3876(08)50042-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The improvement of transfusion medicine technology is an ongoing process primarily directed at increasing the safety of allogeneic blood component transfusions for recipients. Over the years, relatively little attention had been paid to the leukocytes present in the various blood components. The availability of leukocyte removal (leukoreduction) techniques for blood components is associated with a considerable improvement in various clinical outcomes. These include a reduction in the frequency and severity of febrile transfusion reactions, reduced cytomegalovirus transfusion-transmission risk, the reduced incidence of alloimmune platelet refractoriness, a possible reduction in the risk of transfusion-associated variant Creutzfeldt-Jakob disease transmission, as well as reducing the overall risk of both recipient mortality and organ dysfunction, particularly in cardiac surgery patients and possibly in other categories of patients. Internationally, 19 countries have implemented universal leukocyte reduction (ULR) as part of their blood safety policy. The main reason for not implementing ULR in those countries that have not appears to be primarily concerns over costs. Nonetheless, the available international experience supports the concept that ULR is a process that results in improved safety of allogeneic blood components.
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Affiliation(s)
- Wafaa Y Bassuni
- Central Laboratory and Transfusion Services, King Fahad Medical City, Riyadh, Saudi Arabia.
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El Ghouzzi MH, Boiret E, Wind F, Brochard C, Fittere S, Paris L, Mazier D, Sansonetti N, Bierling P. BLOOD DONORS AND BLOOD COLLECTION: Testing blood donors for Chagas disease in the Paris area, France: first results after 18 months of screening. Transfusion 2009; 50:575-83. [DOI: 10.1111/j.1537-2995.2009.02476.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dzib D, Hernández VP, Ake BC, López RA, Monteón VM. Leukoreduction by Centrifugation Does Not EliminateTrypanosoma cruzifrom Infected Blood Units. Vector Borne Zoonotic Dis 2009; 9:235-41. [DOI: 10.1089/vbz.2007.0278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Doris Dzib
- Centro Estatal de la Transfusión Sanguínea de Campeche, SSA, Campeche, Mexico
| | | | - Baldemar Canche Ake
- Centro Estatal de la Transfusión Sanguínea de Campeche, SSA, Campeche, Mexico
| | - Ruth Alacantara López
- Centro de Investigación Enfermedades Tropicales, Universidad Autónoma de Campeche, Campeche, Mexico
| | - Victor Manuel Monteón
- Centro de Investigación Enfermedades Tropicales, Universidad Autónoma de Campeche, Campeche, Mexico
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Cardo LJ, Salata J, Wilder D. Removal ofPlasmodium falciparum-infected red blood cells from whole blood by leukoreduction filters. Transfusion 2009; 49:337-46. [DOI: 10.1111/j.1537-2995.2008.01974.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Riera C, Fisa R, López-Chejade P, Serra T, Girona E, Jiménez M, Muncunill J, Sedeño M, Mascaró M, Udina M, Gállego M, Carrió J, Forteza A, Portús M. Asymptomatic infection by Leishmania infantum in blood donors from the Balearic Islands (Spain). Transfusion 2008; 48:1383-9. [PMID: 18422844 DOI: 10.1111/j.1537-2995.2008.01708.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Visceral leishmaniasis (VL) caused by Leishmania infantum is a zoonotic disease endemic throughout the Mediterranean basin. The existence of asymptomatic human infection entails the risk of transmission by blood transfusion. STUDY DESIGN AND METHODS The prevalence of Leishmania infection was studied in 1437 blood donors from the Balearic Islands (Majorca, Formentera, and Minorca) using immunologic (Western blot [WB] and delayed-type hypersensitivity [DTH]), parasitologic (culture), and molecular (nested polymerase chain reaction [PCR]) methods. In addition, the efficiency of leukoreduction by filtration to remove the parasite was tested by nested PCR in the red blood cell (RBC) units. RESULTS Leishmania antibodies were detected in 44 of the 1437 blood donors tested (3.1%). A sample of 304 donors from Majorca was selected at random. L. infantum DNA was amplified in peripheral blood mononuclear cells (PBMNCs) in 18 of the 304 (5.9%), and cultures were positive in 2 of the 304 (0.6%). DTH was performed on 73 of the 304 donors and was positive for 8 of them (11%). Of the 18 donors with positive L. infantum nested PCR, only 2 were seropositive. All the RBC samples tested (13 of 18) from donors with a positive PBMNC nested PCR yielded negative nested PCR results after leukodepletion. CONCLUSIONS Cryptic Leishmania infection is highly prevalent in blood donors from the Balearic Islands. DTH and L. infantum nested PCR appear to be more sensitive to detect asymptomatic infection than the serology. The use of leukodepletion filters appears to remove parasites from RBC units efficiently.
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Affiliation(s)
- Cristina Riera
- The Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain.
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Pathogen inactivation of Trypanosoma cruzi in plasma and platelet concentrates using riboflavin and ultraviolet light. Transfus Apher Sci 2007; 37:131-7. [DOI: 10.1016/j.transci.2007.07.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 07/13/2007] [Indexed: 11/20/2022]
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Castro E, Gironés N, Bueno JL, Carrión J, Lin L, Fresno M. The efficacy of photochemical treatment with amotosalen HCl and ultraviolet A (INTERCEPT) for inactivation of Trypanosoma cruzi in pooled buffy-coat platelets. Transfusion 2007; 47:434-41. [PMID: 17319823 DOI: 10.1111/j.1537-2995.2007.01133.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study evaluated the efficacy of photochemical treatment (PCT) with amotosalen and ultraviolet A (UVA) light to inactivate Trypanosoma cruzi in contaminated platelet (PLT) components. STUDY DESIGN AND METHODS Fifteen pools of buffy-coat PLTs (BC-PLTs) were inoculated with approximately 5 x 10(3) to 5 x 10(5) per mL of viable T. cruzi of the G, Tulahuen (T), or Y strains. Samples from BC-PLTs were assayed for infectivity before and after PCT with 150 micromol per L amotosalen and 3 J per cm(2) UVA light. Infectivity was determined with three different methods: 1) in vitro culture to detect viable epimastigotes, 2) [(3)H]thymidine incorporation in culture, and 3) in vivo inoculation into interferon-gamma receptor (IFN-gammaR)-deficient mice. RESULTS The in vitro assay yielded viable parasite titers of 3.9 x 10(5), 2.8 x 10(4), and 5.6 x 10(3) per mL (corresponding to 5.6, 4.4, and 3.8 logs/mL) for the Y, T, and G strains, respectively. PCT was able to inactivate all three strains of T. cruzi to below the limit of detection (10 parasites/mL) in the sensitive in vivo assay. Because 10-mL samples, each concentrated into a 1-mL sample for inoculation, were tested in the in vivo assay, log reductions achieved were greater than 5.6, greater than 4.4, and greater than 3.8 for the Y, T, and G strains of T. cruzi, respectively. CONCLUSIONS The pathogen reduction system with amotosalen HCl and UVA demonstrated robust efficacy for inactivation of high doses of three different strains of T. cruzi and offers the potential to make the PLT supply safer.
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Affiliation(s)
- Emma Castro
- From the Spanish Red Cross Transfusion Center, and the National Research Council, Autonomous University of Madrid, Madrid, Spain
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Other Viral, Bacterial, Parasitic and Prion-Based Infectious Complications. BLOOD BANKING AND TRANSFUSION MEDICINE 2007. [PMCID: PMC7152373 DOI: 10.1016/b978-0-443-06981-9.50053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gironés N, Bueno JL, Carrión J, Fresno M, Castro E. The efficacy of photochemical treatment with methylene blue and light for the reduction of Trypanosoma cruzi in infected plasma. Vox Sang 2006; 91:285-91. [PMID: 17105603 DOI: 10.1111/j.1423-0410.2006.00840.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Chagas disease is a transfusion-transmitted infection. This study evaluates the efficacy of a methylene blue (MB) and light system for reducing the viability of Trypanosoma cruzi in plasma. MATERIALS AND METHODS Trypanosoma cruzi strains were spiked in plasma pools. Treatment arms included combined filtration, MB, light and freezing. Post-treatment parasite viability was assayed through in vitro cultures and in vivo inoculation in inducible nitric oxide synthase- and interferon-gamma-receptor-deficient mice. RESULTS The filtration, MB and light combined treatment showed a log reduction of > 3.4 in in vitro cultures, and log reductions that ranged from > 4.9 to > 5.8 in deficient mice inoculated with different T. cruzi strains. CONCLUSION The treatment of plasma units with the MB and light system reduces the T. cruzi burden and could be useful in preventing transfusion-transmitted Chagas disease.
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Affiliation(s)
- N Gironés
- Centro de Transfusión de Cruz Roja Española en Madrid, Madrid, Spain
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de Oliveira RB, Vaz ABM, Alves RO, Liarte DB, Donnici CL, Romanha AJ, Zani CL. Arylfurans as potential trypanosoma cruzi trypanothione reductase inhibitors. Mem Inst Oswaldo Cruz 2006; 101:169-73. [PMID: 16830710 DOI: 10.1590/s0074-02762006000200009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The natural lignans veraguensin and grandisin have been reported to be active against Trypanosoma cruzi bloodstream forms. Aiming at the total synthesis of these and related compounds, we prepared three 2-arylfurans and eight 2,5-diarylfurans. They were evaluated for their potential as T. cruzi trypanothione reductase (TR) inhibitors as well against the parasite's intracellular (amastigote) and bloodstream (trypomastigote) forms. Compound 12 was the most effective against TR with an IC50 of 48.5 microM while 7 and 14 were active against amastigotes, inhibiting the parasite development by 60% at 20 microg/ml (59 and 90 microM, respectively). On the other hand, none of the compounds was significantly active against the parasite bloodstream forms even at 250 microg/ml (0.6-1.5 mM).
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Affiliation(s)
- Renata B de Oliveira
- Laboratório de Quimica de Produtos Naturais, Centro de Pesquisas René Rachou-Fiocruz, Av. Augusto de Lima 1715, 30190-002 Belo Horizonte, MG, Brasil
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Wendel S. Transfusion-transmitted American and African trypanosomiasis (Chagas disease and sleeping sickness): neglected or reality? ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1751-2824.2006.00023.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cardo LJ, Salata J, Harman R, Mendez J, Weina PJ. Leukodepletion filters reduce Leishmania in blood products when used at collection or at the bedside. Transfusion 2006; 46:896-902. [PMID: 16734805 DOI: 10.1111/j.1537-2995.2006.00821.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Leishmania is an intracellular parasite of monocytes transmissible by transfusion. The feasibility of reducing Leishmania with leukodepletion filters was studied. At collection, infected blood contains the amastigote form of Leishmania within monocytes. Amastigotes cause the rupture of monocytes releasing free amastigotes that convert to promastigotes, which exist extracellularly at blood storage temperatures. Leukodepletion filters were tested at various time points in this process. STUDY DESIGN AND METHODS Blood products were infected with Leishmania organisms and then filtered with whole-blood filters at collection, with bedside filters after storage, and to determine whether free promastigotes could be eliminated. RESULTS Filtration at collection reduced Leishmania by 3 to 4 log or to the level of detection. Filtration of infected red cells after 2 weeks of storage showed a reduction of Leishmania by 4 log. Filtration resulted in a 6- to 8-log reduction in promastigotes either in the presence or in the absence of white cells within the filter. CONCLUSION Filtration at the time of collection and after storage of Leishmania-infected blood resulted in a substantial reduction of free and intracellular organisms. There is currently no donor screen for Leishmania. Until adequate testing is developed, the use of leukodepletion filters could add to the safety of the blood supply.
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Affiliation(s)
- Lisa J Cardo
- Division of Military Casualty Research, Department of Blood Research, Transfusion Medicine Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910-7500, USA.
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Hernández-Becerril N, Mejía AM, Ballinas-Verdugo MA, Garza-Murillo V, Manilla-Toquero E, López R, Trevethan S, Cardenas M, Reyes PA, Hirayama K, Monteón VM. Blood transfusion and iatrogenic risks in Mexico city: anti-Trypanosoma cruzi seroprevalence in 43,048 blood donors, evaluation of parasitemia, and electrocardiogram findings in seropositive. Mem Inst Oswaldo Cruz 2005; 100:111-6. [PMID: 16021296 DOI: 10.1590/s0074-02762005000200002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Iatrogenous transmission of Trypanosoma cruzi by blood transfusion was suggested as a potential risk by Pellegrino (1949). Seropositive blood donors in Mexico were first reported in 1978, however, limited information is available due to small sampling, the use of heterogeneous serologic assays, and geographically limited studies. A wide survey carried out in 18 out of the 32 states of Mexico, showed a national mean of 1.6% seropositive among 64,969 donors, ranging from 0.2 to 2.8%. In the present study, we have screened 43,048 voluntary blood donors in a period of five years at the Instituto Nacional de Cardiología I. Chávez, a concentration hospital located in Mexico city which serves mainly the metropolitan area and accepts from all over the country. Standardized ELISA and IIF were used to identify seropositive individuals in addition to hemoculture, PCR and standard 12 lead ECG tests that were applied to a group of seropositive patients (29/161). The result showed a seropositivity of 0.37% (161/43,048). From the group of seropositive individuals 40% (12/29) were potential carriers of T. cruzi at the donation time and 5/29 had subclinical ECG abnormalities. Parasitological tests performed in 70 erythrocyte and platelet fractions from seropositive units (70/161) showed negative results. Our findings strongly support T. cruzi screening in the transfusion medicine practice and identify subclinical heart disease among seropositive blood donors.
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Affiliation(s)
- Nidia Hernández-Becerril
- Laboratorio Inmunoparasitología, Instituto Nacional Cardiología I. Chávez, Juan Badiano 1, Taplan, 14080 México DF
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Affiliation(s)
- D A Leiby
- Transmissible Diseases Department, Jerome H. Holland Laboratory for the Biomedical Sciences, Rockville, MD 20855, USA.
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Abstract
The safety of the blood supply has been a concern over the past 20-30 years because of the transmission of infectious diseases. Blood is still routinely tested for viruses, and leukoreduction is an effective strategy to reduce the transmission of cell-associated viruses. Clinically, the benefits of leukoreduction include decreases in transfusion reactions, HLA alloimmunization, infections, fever episodes, and antibiotic use. Although leukoreduction will add cost to a unit of blood, projections indicate that leukoreduced blood will become the standard of care.
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Affiliation(s)
- Marc J Shapiro
- SUNY-Stony Brook School of Medicine, General Surgery, New York, USA.
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Gushulak BD, MacPherson DW. Globalization of infectious diseases: the impact of migration. Clin Infect Dis 2004; 38:1742-8. [PMID: 15227621 DOI: 10.1086/421268] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Accepted: 02/04/2004] [Indexed: 12/18/2022] Open
Abstract
With up to 2% of the world's population living outside of their country of birth, the potential impact of population mobility on health and on use of health services of migrant host nations is increasing in its importance. The drivers of mobility, the process of the international movement, and the back-and-forth transitioning between differential risk environments has significance for the management of infectious diseases in migrant receiving areas. The management issues are broad, high-level, and cross-cutting, including policy decisions on managing the migration process for skilled-labor requirements, population demographic and biometric characteristics, and family reunification; to program issues encompassing health care professional education, training, and maintenance of competence; communication of global events of public health significance; development of management guidelines, particularly for nonendemic diseases; access to diagnostic and therapeutic interventions for exotic or rare clinical presentations; and monitoring of health service use and health outcomes in both the migrant and local populations.
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Affiliation(s)
- Brian D Gushulak
- Medical Services Branch, Citizenship and Immigration Canada, Ottawa, Ontario, Canada.
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Abstract
In the next decade, many of the methodologies and research reviewed in this article will become clinical practice, making the transfusion of blood products safer and more universally available than they are today. NAT will be standard and will surely be performed on each unit of product, PCR testing for pathogens will evolve, and the pathophysiology and immunology of transfusion-related events such as TRALI and immunomodulation will be elucidated. New methods of preservation and early detection of contamination will extend the life of blood products. Red blood cell antigens may be attenuated, making safe products available to more patients. Clinical vigilance at the bedside and in the blood bank will remain key areas for transfusion safety. As I have told many a resident and patient, blood is not saline; there are and will remain risks inherent in this commonly used medical therapy.
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Affiliation(s)
- Keith C Quirolo
- Department of Clinical Laboratory Medicine, University of California, San Francisco, Moffitt-Long Hospital, 505 Parnassus Avenue, San Francisco, CA 94143-0100, USA.
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Moraes-Souza H, Pianetti GM, Barretto OCDOP, Nonoyama K, Grolg M, Chiari E. Aminoquinolone WR6026 as a feasible substitute for gentian violet in Chagas' disease prophylaxis in preserved blood for transfusional purposes. Rev Soc Bras Med Trop 2002; 35:563-9. [PMID: 12612735 DOI: 10.1590/s0037-86822002000600003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The search for a colorless, nontoxic and efficient drug to prevent transfusion-associated Chagas' disease (TACD) has been underway unsuccessfully since 1953 when gentian violet was preconized and to date is still being used as the only in vitro trypanocidal agent. The recent findings of aminoquinolone "WR6026" as a trypanocidal agent, led the authors to study the metabolism of red cells stored with this compound, the main objective of which was to define its applicability in TACD control. Ten units of human whole blood collected in CPDA-1 were divided into two equal satellite bags. One had "WR6026" (final concentration 62.5 g/mL) added and the other was used as a control, both were stored at 4 C. At baseline, day 7, 14, 21 and 28, samples were taken for the following measurements: adenosine triphosphate (ATP), hemoglobin, electrolytes (sodium and potassium), gases (pO2 and pCO2) and osmotic fragility. The results of tests and control were analyzed through parametric t-student test. The results were similar in both groups throughout the experiment except for the level of ATP on day 14, which presented significantly higher values in the tests when compared with the controls (p = 0.012). It was concluded that WR6026 does not interfere in the preservation and probably the viability of the erythrocytes also until day 28 of storage. Consequently the authors suggest that WR6026 could emerge as a colorless substitute for gentian violet in the control of TACD in endemic areas.
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Abstract
BACKGROUND Routine leukocyte-depletion (LD) of cellular blood products, and even plasma, is currently being implemented in most European countries, as a result of the fear that the variant Creutzfeldt-Jakob-disease (vCJD) might be transmissible by transfusion. However, not only is the scientific evidence supporting such a notion scarce, but the benefits of applying this procedure to all patients also remain unfounded. METHODS A MEDLINE-research for studies dealing with the indications for LD was performed. In addition, the guidelines and recommendations of national and international health authorities were scrutinized. RESULTS To date,the only proven benefit of LD that can be applied to all patients is the reduction of non-hemolytic febrile transfusion reactions. In addition, LD reduces HLA-immunization and platelet refractoriness in multi-transfused patients. In immunocompromized patients, LD reduces transfusion-transmitted CMV-disease. Furthermore, a minority of 5-10% of transfusion-related-acute-lung-injury cases can be prevented by LD. However, the potential of reducing the immunomodulating effects of transfusion such as postoperative infection, cancer-recurrence-related or overall mortality and of reducing septicemia due to bacterial contamination is still at issue. AIDS patients do not benefit from LD, at least. The suitability of LD for preventing the transmission of vCJD is at best hypothetical. Potential risks of LD like increased leakages have not been taken into account adequately to date. CONCLUSIONS At present, the scientific evidence does not justify the introduction of LD as a routine measure. In times of limited health care resources, this costly procedure might limit access to medical services with proven effectiveness and efficiency. In addition, the loss of 5-10% of the red cell pool is predicted to lead to more blood supply shortages than previously seen.
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Affiliation(s)
- Ralf Karger
- Institut für Transfusionsmedizin und Hämostaseologie, Klinikum der Philipps Universität Marburg, Germany
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33
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Affiliation(s)
- J D Sweeney
- Department of Transfusion Medicine and Coagulation, Brown University School of Medicine, and Lifespan Academic Medical Center, Miriam Hospital, Providence, RI, USA
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Fabron Júnior A, Bordin JO, Moraes-Souza H, FreyMüller E, Lages-Silva E. Removal of Trypanosoma cruzi by white cell-reduction filters: an electronmicroscopic study. Rev Soc Bras Med Trop 1999; 32:223-7. [PMID: 10380559 DOI: 10.1590/s0037-86821999000300001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
White cell (WBC)-reduction filters have been shown to be effective in removing infectious agents from infected blood products. In this study, the mechanisms of Trypanosoma cruzi (T. cruzi) retention by WBC-reduction filters were assessed. Human packed red blood cell (PRBC) and platelet concentrate (PC) samples were contaminated with T. cruzi organisms (Y strain; 3.4 x 10(6)/ml), and then filtered using WBC-reduction experimental filters that provided about 3 log10 WBC removal. Transmission electron microscopy sections showed that T. cruzi parasites were removed from contaminated PRBC and PC samples primarily by mechanical mechanism without interacting with filter fibers or blood cells. In addition, we found that T. cruzi parasites were also removed by a direct fiber adhesion. These data indicate that T. cruzi parasites are removed from infected blood not only by mechanical mechanism but also by biological mechanism probably mediated by parasite surface proteins.
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Affiliation(s)
- A Fabron Júnior
- Escola Paulista de Medicina da Universidade Federal de São Paulo, Brasil
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Alves TM, Alves R, Romanha AJ, Zani CL, dos Santos MH, Nagem TJ. Biological activities of 7-epiclusianone. JOURNAL OF NATURAL PRODUCTS 1999; 62:369-371. [PMID: 10075791 DOI: 10.1021/np9803833] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
7-Epiclusianone, isolated from Rheedia gardneriana, was tested in several biological assays. It was active in vitro against trypomastigotes of Trypanosoma cruzi but inactive in vivo in experimentally infected mice. It was also active against Artemia salina, but inactive against the fungus Cladosporium sphaerospermum and the snail Biomphalaria glabrata.
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Affiliation(s)
- T M Alves
- Centro de Pesquisas "René Rachou"-FIOCRUZ-Av. Augusto de Lima, 1715, CEP 30190-002, Belo Horizonte, MG, Brazil.
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Zani CL, Chiari E, Krettli AU, Murta SM, Cunningham ML, Fairlamb AH, Romanha AJ. Anti-plasmodial and anti-trypanosomal activity of synthetic naphtho[2,3-b]thiopen-4,9-quinones. Bioorg Med Chem 1997; 5:2185-92. [PMID: 9459016 DOI: 10.1016/s0968-0896(97)00155-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Naphtho[2,3-b]thiophen-4,9-quinone and five derivatives were prepared using the Friedel-Crafts reaction and tandem-lithiation of aromatic diethylamides. These quinones were evaluated for their trypanocidal and anti-plasmodial activities by their effects on: (1) growth of epimastigote forms of Trypanosoma cruzi in vitro, (2) lysis of trypomastigote forms of T. cruzi in murine blood, (3) growth of Plasmodium falciparum in vitro, and (4) inhibition of the recombinant enzyme trypanothione reducatase. The parent compound, naphtho[2,3-b]thiophen-4,9-quinone (3a), was among the most active quinone tested in vitro against P. falciparum at 0.2 microM. However, it was inactive against P. berghei-infected mice treated with 2.3 mmol/kg daily for 5 days. Most of the quinones prepared were active against T. cruzi epimastigotes in culture but exhibited weak activity at 4 degrees C against trypomastigotes in murine blood as well against the enzyme trypanothione reducatase. Further structural modifications will be necessary to improve the in vivo activity of the naphthothiophenquinones.
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Affiliation(s)
- C L Zani
- Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, MG, Brazil.
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Ribeiro A, Piló-Veloso D, Romanha AJ, Zani CL. Trypanocidal flavonoids from Trixis vauthieri. JOURNAL OF NATURAL PRODUCTS 1997; 60:836-841. [PMID: 9287419 DOI: 10.1021/np970196p] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The crude extract of Trixis vauthieri (Asteraceae) was active against the trypomastigote forms of Trypanosoma cruzi, the protozoan that causes Chagas' disease. Bioassay-guided fractionation of this extract afforded the trypanocidal flavonoids 5,4'-dihydroxy-7-methoxyflavanone (1) and 5,4'-dihydroxy-3,6,7-trimethoxyflavone (2) besides the inactive flavonoids 3,5,4'-trihydroxy-7-methoxyflavanone (3) and 5,4'-dihydroxy-3,6,7,8-tetramethoxy flavone (4). The trypanocidal activity of 1 and 2 and the presence of compounds 2 and 4 in Trixis vauthieri are reported here for the first time.
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Affiliation(s)
- A Ribeiro
- Departamento de Química-ICEx-UFMG, Belo Horizonte, MG, Brazil
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38
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Abstract
Available epidemiological data indicate that Chagas' disease, a zoonosis caused by the flagellate protozoan parasite T cruzi, is a very important medical and social problem in Latin America. More than 60% of T cruzi-infected individuals have migrated to urban areas, in both endemic and nonendemic countries. Thus, with the implementation and maintenance of regular vector control programs in some countries, allogeneic blood transfusions have been the main mechanism for the continuation of this endemy. The risk of infection after transfusion of a unit of T cruzi-infected blood product depends mainly on the amount of blood transfused, parasite concentration in the infected transfused blood unit, and the recipient's immunological status. Current strategies to prevent transfusion-associated Chagas' disease include the identification of T cruzi-infected blood donors by predonation questionnaire, serological tests for T cruzi antibodies, and the treatment of the blood collected with gentian violet. Because T cruzi infection is lifelong, and most infected persons are asymptomatic, the identification of high-risk blood donors by a predonation questionnaire is relevant in nonendemic countries but this strategy seems to be of limited usefulness for donor deferral in endemic areas. Because T cruzi antigens are shared by other parasites, the serological diagnosis of T cruzi infection is complex yielding both false-positive and false-negative results. Although sensitive, the tests currently available for the serodiagnosis of T cruzi infection lack specificity and a more specific, confirmatory test is still needed for the routine confirmation of T cruzi chronic infection. In areas of high endemicity or where serological screening is not available, the risk of T cruzi transmission by blood transfusion may be reduced by the addition of gentian violet to the collected blood. The use of gentian violet, alone or combined with ascorbic acid and light, effectively inactivate T cruzi present in donor blood; however, the long-term toxicity of this agent for blood recipients is still an open issue. In conclusion, the prevention of TA-CD is based on various strategies that are not mutually exclusive. Blood donor education, identification of putatively infectious blood donors by questionnaire or serological screening tests, and methods of parasite inactivation may significantly reduce the transmission of T cruzi by allogeneic blood transfusions.
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Affiliation(s)
- H Moraes-Souza
- Faculdade de Medicina do Triângulo Mineiro Fundaçäo Hemominas, Uberaba, MG, Brazil
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