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Yin M, Zhang HB, Tao Y, Yao JM, Liu H, Win HH, Huo LL, Jiang B, Chen JX. Optimization of an Evaluation Method for Anti-Babesia microti Drug Efficacy. Acta Trop 2022; 225:106179. [PMID: 34627758 DOI: 10.1016/j.actatropica.2021.106179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022]
Abstract
Babesiosis is an emerging zoonotic disease that is typically caused by Babesia microti infection. Clinical treatment of B. microti infection is challenging; hence, it is crucial to find new effective drugs. The current laboratory screening methods for anti-B. microti drugs are not optimized. We conducted drug-suppressive and drug-therapeutic tests to investigate whether use of an immunosuppressant and the target gene-based qPCR are helpful to reduce the number of animals affected and to improve parasite detection in an immunocompetent mouse model. These results were verified by subpassage test. In the drug-suppressive test, no B. microti were observed after immunosuppressant administration or in subpassage mice in the 100 mg/kg robenidine hydrochloride (ROBH) group. The opposite results were observed in the control, 50 mg/kg ROBH, atovaquone (ATO) + azithromycin (AZM), and proguanil hydrochloride (PGH) groups. Significant differences were observed in the EIR and target gene relative values (both P < 0.001) between the control group and any ROBH groups. In the drug-therapeutic test, recrudescence occurred in the 50 mg/kg ROBH, ATO+AZM, and control groups. This was not observed in the 100 mg/kg ROBH group after immunosuppressant administration. Similar findings were observed in the subpassage test. This suggests that a 4-day anti-B. microti drug-suppressive test can be used in preliminary drug screening. Potentially effective drugs can be verified by immunosuppressant test in subsequent drug-therapeutic tests. Thus, a laboratory evaluation method of anti-B. microti drug efficacy was optimized, which is highly accurate and requires a short drug screening time.
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McCullough J. Transfusion‐Transmitted Diseases. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Persistence of Babesia microti Infection in Humans. Pathogens 2019; 8:pathogens8030102. [PMID: 31319461 PMCID: PMC6789900 DOI: 10.3390/pathogens8030102] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 01/13/2023] Open
Abstract
Persistent infection is a characteristic feature of babesiosis, a worldwide, emerging tick-borne disease caused by members of the genus Babesia. Persistence of Babesia infection in reservoir hosts increases the probability of survival and transmission of these pathogens. Laboratory tools to detect Babesia in red blood cells include microscopic detection using peripheral blood smears, nucleic acid detection (polymerase chain reaction and transcription mediated amplification), antigen detection, and antibody detection. Babesia microti, the major cause of human babesiosis, can asymptomatically infect immunocompetent individuals for up to two years. Chronically infected blood donors may transmit the pathogen to another person through blood transfusion. Transfusion-transmitted babesiosis causes severe complications and death in about a fifth of cases. Immunocompromised patients, including those with asplenia, HIV/AIDS, malignancy, or on immunosuppressive drugs, often experience severe disease that may relapse up to two years later despite anti-Babesia therapy. Persistent Babesia infection is promoted by Babesia immune evasive strategies and impaired host immune mechanisms. The health burden of persistent and recrudescent babesiosis can be minimized by development of novel therapeutic measures, such as new anti-parasitic drugs or drug combinations, improved anti-parasitic drug duration strategies, or immunoglobulin preparations; and novel preventive approaches, including early detection methods, tick-avoidance, and blood donor screening.
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Brennan MB, Herwaldt BL, Kazmierczak JJ, Weiss JW, Klein CL, Leith CP, He R, Oberley MJ, Tonnetti L, Wilkins PP, Gauthier GM. Transmission of Babesia microti Parasites by Solid Organ Transplantation. Emerg Infect Dis 2018; 22. [PMID: 27767010 PMCID: PMC5088010 DOI: 10.3201/eid2211.151028] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infection with this parasite should be included in differential diagnosis of fever and anemia after blood transfusion or organ transplantation. Babesia microti, an intraerythrocytic parasite, is tickborne in nature. In contrast to transmission by blood transfusion, which has been well documented, transmission associated with solid organ transplantation has not been reported. We describe parasitologically confirmed cases of babesiosis diagnosed ≈8 weeks posttransplantation in 2 recipients of renal allografts from an organ donor who was multiply transfused on the day he died from traumatic injuries. The organ donor and recipients had no identified risk factors for tickborne infection. Antibodies against B. microti parasites were not detected by serologic testing of archived pretransplant specimens. However, 1 of the organ donor’s blood donors was seropositive when tested postdonation and had risk factors for tick exposure. The organ donor probably served as a conduit of Babesia parasites from the seropositive blood donor to both kidney recipients. Babesiosis should be included in the differential diagnosis of unexplained fever and hemolytic anemia after blood transfusion or organ transplantation.
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Wardrop KJ, Birkenheuer A, Blais MC, Callan MB, Kohn B, Lappin MR, Sykes J. Update on Canine and Feline Blood Donor Screening for Blood-Borne Pathogens. J Vet Intern Med 2016; 30:15-35. [PMID: 26806261 PMCID: PMC4913655 DOI: 10.1111/jvim.13823] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/02/2022] Open
Abstract
An update on the 2005 American College of Veterinary Internal Medicine (ACVIM) Consensus Statement on blood donor infectious disease screening was presented at the 2015 ACVIM Forum in Indianapolis, Indiana, followed by panel and audience discussion. The updated consensus statement is presented below. The consensus statement aims to provide guidance on appropriate blood‐borne pathogen testing for canine and feline blood donors in North America.
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Affiliation(s)
- K J Wardrop
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA
| | - A Birkenheuer
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - M C Blais
- Department of Clinical Sciences, Faculté de médecine vétérinaire, Université de Montreal, Montreal, QC
| | - M B Callan
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - B Kohn
- Clinic of Small Animals, Faculty of Veterinary Medicine, Freie Universitat Berlin, Berlin, Germany
| | - M R Lappin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - J Sykes
- Department of Medicine and Epidemiology, University of California, Davis, CA
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Transfusion-Transmitted Diseases. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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7
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Fang DC, McCullough J. Transfusion-Transmitted Babesia microti. Transfus Med Rev 2016; 30:132-8. [DOI: 10.1016/j.tmrv.2016.04.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 01/19/2023]
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McCullough J, Goldfinger D, Gorlin J, Riley WJ, Sandhu H, Stowell C, Ward D, Clay M, Pulkrabek S, Chrebtow V, Stassinopoulos A. Cost implications of implementation of pathogen-inactivated platelets. Transfusion 2015; 55:2312-20. [PMID: 25989465 PMCID: PMC4691315 DOI: 10.1111/trf.13149] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pathogen inactivation (PI) is a new approach to blood safety that may introduce additional costs. This study identifies costs that could be eliminated, thereby mitigating the financial impact. STUDY DESIGN AND METHODS Cost information was obtained from five institutions on tests and procedures (e.g., irradiation) currently performed, that could be eliminated. The impact of increased platelet (PLT) availability due to fewer testing losses, earlier entry into inventory, and fewer outdates with a 7-day shelf life were also estimated. Additional estimates include costs associated with managing 1) special requests and 2) test results, 3) quality control and proficiency testing, 4) equipment acquisition and maintenance, 5) replacement of units lost to positive tests, 6) seasonal or geographic testing, and 7) health department interactions. RESULTS All costs are mean values per apheresis PLT unit in USD ($/unit). The estimated test costs that could be eliminated are $71.76/unit and a decrease in transfusion reactions corresponds to $2.70/unit. Avoiding new tests (e.g., Babesia and dengue) amounts to $41.80/unit. Elimination of irradiation saves $8.50/unit, while decreased outdating with 7-day storage can be amortized to $16.89/unit. Total potential costs saved with PI is $141.65/unit. Costs are influenced by a variety of factors specific to institutions such as testing practices and the location in which such costs are incurred and careful analysis should be performed. Additional benefits, not quantified, include retention of some currently deferred donors and scheduling flexibility due to 7-day storage. CONCLUSIONS While PI implementation will result in additional costs, there are also potential offsetting cost reductions, especially after 7-day storage licensing.
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Affiliation(s)
- Jeffrey McCullough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Dennis Goldfinger
- Department of Laboratory Medicine and Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jed Gorlin
- Memorial Blood Centers/Innovative Blood Resources, St Paul, Minnesota
| | - William J Riley
- College of the Science of Health Care Delivery, Arizona State University, Tempe, Arizona
| | - Harpreet Sandhu
- Stanford Blood Center, Stanford University School of Medicine, Stanford, California
| | - Christopher Stowell
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dawn Ward
- Department of Laboratory Medicine and Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mary Clay
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Shelley Pulkrabek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Vera Chrebtow
- Global Scientific Affairs, Cerus Corporation, Concord, California
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Wang H, Huang F. Babesia infection in the southwest of china, a case report. Jundishapur J Microbiol 2014; 7:e13504. [PMID: 25774278 PMCID: PMC4332240 DOI: 10.5812/jjm.13504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/25/2013] [Accepted: 10/05/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Babesiosis is caused by apicomplexa parasites of the genus Babesia. Humans are commonly infected by Babesia through tick bites. There is limited information available about Babesia infection of humans in China. The aim of this study was to isolate the pathogen from a patient with severe parasitemia. CASE PRESENTATION Blood samples were observed by transmission electron microscopy (TEM) and indirect fluorescent antibody (IFA), and red blood cells of bone marrow and blood smears were examined by a microscope. The patient was infected by Babesia and cured after a combined treatment. CONCLUSIONS Babesia infection was detected in an individual from China.
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Affiliation(s)
- Huixuan Wang
- Clinical Laboratory, Kunming General Hospital of Chengdu Military Region, Kunming, PR China
- Corresponding author: Huixuan Wang, Kunming General Hospital of Chengdu Military Region, Kunming, PR China. Tel: +86-87164774236, Fax: +86-87164774236, E-mail:
| | - Fen Huang
- Clinical Laboratory, Kunming General Hospital of Chengdu Military Region, Kunming, PR China
- Medical Faculty, Kunming University of Science and Technology, Kunming, PR China
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Leiby DA, Johnson ST, Won KY, Nace EK, Slemenda SB, Pieniazek NJ, Cable RG, Herwaldt BL. A longitudinal study of Babesia microti infection in seropositive blood donors. Transfusion 2014; 54:2217-25. [PMID: 24673297 DOI: 10.1111/trf.12622] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/03/2014] [Accepted: 01/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Babesia infection is caused by intraerythrocytic tick-borne parasites. Cases of transfusion-transmitted babesiosis have been increasingly recognized. To date, no Babesia test has been licensed for screening US blood donors. We conducted a longitudinal study to assess the course and markers of Babesia infection among seropositive donors identified in a seroprevalence study. STUDY DESIGN AND METHODS Eligible donors had B. microti indirect fluorescent antibody (IFA) titers of 64 or greater. Enrollees were monitored up to 3 years, by IFA and three methods for evidence of parasitemia: B. microti nested polymerase chain reaction (PCR) analysis (at two laboratories), hamster inoculation, and blood-smear examination. RESULTS Among 115 eligible donors, 84 (73%) enrolled. Eighteen enrollees (21%) had evidence of parasitemia for 30 total specimens (17% of 181), which were collected in 9 different months and tested positive by various approaches: PCR (25 specimens/16 persons), hamster inoculation (13 specimens/8 persons), and blood smear (one specimen positive by all three approaches). Overall, 14 persons had one or more specimen with positive PCR results at both laboratories (12 persons) and/or had parasitologically confirmed infection (eight persons). Three of nine persons who had more than one specimen with evidence of parasitemia had nonconsecutive positives. Several enrollees likely had been infected at least 1 year when their last positive specimen was collected. The final three specimens for seven persons tested negative by all study methods, including IFA. CONCLUSION Seropositive blood donors can have protracted low-level parasitemia that is variably and intermittently detected by parasitologic and molecular methods. Donor-screening algorithms should include serologic testing and not solely rely on molecular testing.
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Affiliation(s)
- David A Leiby
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland
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Fritzen C, Mosites E, Applegate RD, III SRT, Huang J, Yabsley MJ, Carpenter LR, Dunn JR, Moncayo AC. Environmental Investigation Following the First Human Case of Babesiosis in Tennessee. J Parasitol 2014; 100:106-9. [DOI: 10.1645/12-158.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chan K, Marras SAE, Parveen N. Sensitive multiplex PCR assay to differentiate Lyme spirochetes and emerging pathogens Anaplasma phagocytophilum and Babesia microti. BMC Microbiol 2013; 13:295. [PMID: 24359556 PMCID: PMC3890647 DOI: 10.1186/1471-2180-13-295] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/12/2013] [Indexed: 12/24/2022] Open
Abstract
Background The infection with Borrelia burgdorferi can result in acute to chronic Lyme disease. In addition, coinfection with tick-borne pathogens, Babesia species and Anaplasma phagocytophilum has been increasing in endemic regions of the USA and Europe. The currently used serological diagnostic tests are often difficult to interpret and, moreover, antibodies against the pathogens persist for a long time making it difficult to confirm the cure of the disease. In addition, these tests cannot be used for diagnosis of early disease state before the adaptive immune response is established. Since nucleic acids of the pathogens do not persist after the cure, DNA-based diagnostic tests are becoming highly useful for detecting infectious diseases. Results In this study, we describe a real-time multiplex PCR assay to detect the presence of B. burgdorferi, B. microti and A. phagocytophilum simultaneously even when they are present in very low copy numbers. Interestingly, this quantitative PCR technique is also able to differentiate all three major Lyme spirochete species, B. burgdorferi, B. afzelii, and B. garinii by utilizing a post-PCR denaturation profile analysis and a single molecular beacon probe. This could be very useful for diagnosis and discrimination of various Lyme spirochetes in European countries where all three Lyme spirochete species are prevalent. As proof of the principle for patient samples, we detected the presence of low number of Lyme spirochetes spiked in the human blood using our assay. Finally, our multiplex assay can detect all three tick-borne pathogens in a sensitive and specific manner irrespective of the level of each pathogen present in the sample. We anticipate that this novel diagnostic method will be able to simultaneously diagnose early to chronic stages of Lyme disease, babesiosis and anaplasmosis using the patients’ blood samples. Conclusion Real-time quantitative PCR using specific primers and molecular beacon probes for the selected amplicon described in this study can detect three tick-borne pathogens simultaneously in an accurate manner.
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Affiliation(s)
| | | | - Nikhat Parveen
- Department of Microbiology and Molecular Genetics, Rutgers-New Jersey Medical School, 225 Warren Street, Newark, NJ 07103-3535, USA.
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Tonnetti L, Thorp AM, Deisting B, Bachowski G, Johnson ST, Wey AR, Hodges JS, Leiby DA, Mair D. Babesia microti seroprevalence in Minnesota blood donors. Transfusion 2012; 53:1698-705. [PMID: 23145838 DOI: 10.1111/j.1537-2995.2012.03948.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/04/2012] [Accepted: 09/18/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The increasing frequency of transfusion-transmitted babesiosis represents a concern for the safety of the US blood supply. The agent responsible for the disease, the intraerythrocytic parasite Babesia microti, is naturally transmitted to humans by a tick bite and is endemic in areas of the Northeast and Upper Midwest United States. In this study, we explored B. microti seroprevalence in blood donors from different areas of Minnesota (MN). STUDY DESIGN AND METHODS We tested 2150 blood donors in MN for the presence of antibodies against B. microti using an immunofluorescent assay (IFA). Donors identified as positive (≥64) were also tested by real-time polymerase chain reaction (PCR) for the presence of parasite DNA. Seropositive donors were contacted by phone and asked questions regarding tick exposure. Donors positive by IFA were indefinitely deferred from donating blood. RESULTS A total of 2150 donations were tested between October 2010 and November 2011. Forty-two donors (2.0%) were positive by IFA and one was also PCR positive. All positive donors reported extended outdoor activities, 12 recalled finding ticks on their body, and six had flu-like symptoms since their last blood draw. CONCLUSIONS This study provides new data about B. microti seroprevalence in MN blood donors. Possibly because the targeted collection areas were mostly expected to be endemic for the parasite, the observed seroprevalence levels were higher than expected, although the geographic distribution of positive donors did not completely overlap with the distribution of reported clinical cases in MN.
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Affiliation(s)
- Laura Tonnetti
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, Maryland 20855, USA.
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Multiplex assay detection of immunoglobulin G antibodies that recognize Babesia microti antigens. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1539-48. [PMID: 22855390 DOI: 10.1128/cvi.00313-12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Human babesiosis, a blood-borne infection caused by several species of Babesia, including B. microti, is an emerging disease that is endemic in the Northeast, upper Midwest, and Pacific Northwest regions of the United States. Risk factors for babesiosis include exposure to the infected tick vector and blood transfusions from infected donors. In this work, we cloned and expressed two of the immunodominant antigens from B. microti and used them in a multiplex bead format assay (MBA) to detect parasite-specific IgG responses in human sera. The MBA using recombinant B. microti secreted antigen 1 (BmSA1) protein was more specific (100%) and slightly more sensitive (98.7%) than the assay using a truncated recombinant BMN1-17 construct (97.6% and 97.4%, respectively). Although some antibody reactivity was observed among sera from confirmed-malaria patients, only one Plasmodium falciparum sample was simultaneously positive for IgG antibodies to both antigens. Neither antigen reacted with sera from babesiosis patients who were infected with Babesia species other than B. microti. Both positive and negative MBA results were reproducible between assays and between instruments. Additional studies of these recombinant antigens and of the multiplex bead assay using blood samples from clinically defined babesiosis patients and from blood donors are needed to more clearly define their usefulness as a blood screening assay.
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Bloch EM, Herwaldt BL, Leiby DA, Shaieb A, Herron RM, Chervenak M, Reed W, Hunter R, Ryals R, Hagar W, Xayavong MV, Slemenda SB, Pieniazek NJ, Wilkins PP, Kjemtrup AM. The third described case of transfusion-transmitted Babesia duncani. Transfusion 2011; 52:1517-22. [DOI: 10.1111/j.1537-2995.2011.03467.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Transfusion‐Transmitted Diseases. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Simonsen KA, Harwell JI, Lainwala S. Clinical presentation and treatment of transfusion-associated babesiosis in premature infants. Pediatrics 2011; 128:e1019-24. [PMID: 21890833 DOI: 10.1542/peds.2010-0502] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We review here 7 cases of neonatal transfusion-associated babesiosis at a NICU in the northeast United States. Transfusion from 2 infected units of blood resulted in the 7 cases described. The clinical presentation was highly variable in this cohort; the extremely low birth weight neonates were the most severely affected. Antibiotic therapy was effective in neonates with mild and asymptomatic infection; however, double-volume exchange blood transfusion with prolonged multidrug treatment was required for the 2 most severe cases. The risk of Babesia microti infection is not eliminated through current blood-bank practices. Neonatologists in endemic areas should have a high index of suspicion for babesiosis in premature infants exposed to blood transfusions.
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Affiliation(s)
- Kari A Simonsen
- Pediatric Infectious Diseases, University of Nebraska Medical Center, 982162 Nebraska Medical Center, Omaha, Nebraska 68198-2162, USA.
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Johnson ST, Cable RG, Leiby DA. Lookback investigations of Babesia microti-seropositive blood donors: seven-year experience in a Babesia-endemic area. Transfusion 2011; 52:1509-16. [PMID: 21910741 DOI: 10.1111/j.1537-2995.2011.03345.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human babesiosis in the United States is primarily attributable to infection with the intraerythrocytic protozoan parasite, Babesia microti. Transfusion-transmitted Babesia (TTB) is a mounting blood safety concern; approximately 100 US cases of TTB have been reported since 1980. In response, market withdrawal (MW) and/or lookback (LB) has been advocated for cellular components derived from Babesia-positive blood donors. STUDY DESIGN AND METHODS Immunofluorescence assay (IFA) and selective polymerase chain reaction (PCR) testing of Connecticut donors was conducted from 1999 through 2005. MW/LB was initiated following established procedures on cellular components derived from IFA and/or PCR-positive donors. Recipients of these associated components were offered IFA and PCR testing for B. microti. RESULTS A total of 208 seropositive donors were identified, with 474 donations and 656 cellular components subject to MW/LB. Sixty-three recipients were tested for B. microti; eight (12.7%) were IFA and/or PCR positive. A significantly higher proportion of B. microti-positive recipients were identified by LB in 1999 to 2000 (5 of 15, 33.3%) than after implementation of seropositive donor deferral in 2001 (3 of 48, 6.3%). Significant differences in positive LBs were also found when comparing index (50% positive) to previous donations (7.3% positive), and when comparing demonstrably parasitemic to nonparasitemic donors, 33.3 and 2.9%, respectively. CONCLUSIONS Recipients of components from B. microti-positive donors were infected via transfusion, with index donations from parasitemic donors posing the greatest transmission risk. This report of B. microti transmission detected through LB, coupled with ongoing TTB cases, indicates that interventions are needed to reduce transmission of B. microti to US blood recipients.
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Affiliation(s)
- Stephanie T Johnson
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Farmington, CT, USA.
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Wudhikarn K, Perry EH, Kemperman M, Jensen KA, Kline SE. Transfusion-transmitted babesiosis in an immunocompromised patient: a case report and review. Am J Med 2011; 124:800-5. [PMID: 21683324 DOI: 10.1016/j.amjmed.2011.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 02/11/2011] [Accepted: 03/08/2011] [Indexed: 11/25/2022]
Abstract
Babesiosis is a tick- and transfusion-borne disease caused by intraerythrocytic Babesia parasites. In 2009, a 61-year-old Minnesota woman with chronic lymphocytic leukemia and a history of recent chemotherapy and numerous blood transfusions for gastrointestinal bleeding became febrile and anemic 12 days postsplenectomy. Babesia were visualized on blood smears, confirmed by polymerase chain reaction as B. microti. She developed respiratory failure despite initiation of clindamycin and quinine, and required 12 weeks of azithromycin and atovaquone before blood smear and polymerase chain reaction findings were negative. Serologic evidence of B. microti infection was identified in 1 associated blood donor and 1 other recipient of that donor's blood. Babesia infection can be asymptomatic or cause mild to fulminant disease resulting in multiorgan failure or death. Patients with advanced age, asplenia, or other immune compromise are at risk for severe babesiosis and may require prolonged treatment to eradicate parasitemia. Incidence of transfusion-transmitted babesiosis has increased over the past decade.
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Nicholson GT, Walsh CA, Madan RP. Transfusion-associated Babesiosis in a 7-month-old Infant after Bidirectional Glenn Procedure. CONGENIT HEART DIS 2010; 5:607-13. [DOI: 10.1111/j.1747-0803.2010.00384.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Johnson ST, Cable RG, Tonnetti L, Spencer B, Rios J, Leiby DA. TRANSFUSION COMPLICATIONS: Seroprevalence of Babesia microti in blood donors from Babesia-endemic areas of the northeastern United States: 2000 through 2007. Transfusion 2009; 49:2574-82. [DOI: 10.1111/j.1537-2995.2009.02430.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, Wingard JR, Young JAH, Boeckh MJ, Boeckh MA. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15:1143-238. [PMID: 19747629 PMCID: PMC3103296 DOI: 10.1016/j.bbmt.2009.06.019] [Citation(s) in RCA: 1170] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 06/23/2009] [Indexed: 02/07/2023]
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Abstract
BACKGROUND Babesiosis is caused by an intraerythrocytic protozoan transmitted by ticks. Blood transfusion is another mode of transmission. STUDY DESIGN AND METHODS This was a retrospective study based on babesiosis cases reported to the Rhode Island Department of Health between 1999 and 2007. Additional cases were also identified. RESULTS Twenty-one cases of transfusion-transmitted babesiosis (TTB) were identified from 1999 through 2007. From 2005 through 2007, the incidence approached one case per 9000 units of blood transfused. One of 21 (5%) TTB cases was diagnosed in July, in sharp contrast to 65 of 152 (43%) of the total babesiosis cases diagnosed during July in Rhode Island. Many cases were identified when a complete blood count with a differential was routinely requested and parasites were noted by laboratory technologists. Most patients with TTB had underlying conditions known to predispose to symptomatic infection. CONCLUSION Blood transfusion is an important mode of Babesia transmission. The current screening method of omitting donors with a history of babesiosis may be effective in preventing some, but not all, cases of TTB and current processing of blood products does not eradicate this parasite. Thus, a better screening test is needed. Alternatively, pathogen reduction technology could be utilized to prevent this mode of transmission.
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Affiliation(s)
- Shadaba Asad
- Division of Infectious Diseases, Department of Medicine, and Transfusion Medicine, Rhode Island Hospital, Providence, RI 02903, USA
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Abstract
Human babesiosis is an emerging intraerythrocytic infection caused by protozoal parasites transmitted by ixodid ticks. Babesiosis is endemic in the northeastern and upper midwestern regions of the United States and is found sporadically in other parts of the United States, Europe, Asia, Africa, and South America. Babesial infections range from asymptomatic to severe and occasionally are fatal. Specific laboratory diagnosis of babesial infection is made by morphologic examination of Giemsa-stained blood smears, serology, and amplification of babesial DNA using polymerase chain reaction. The combination of atovaquone and azithromycin is the treatment of choice for mild-to-moderate illness, whereas clindamycin and quinine and exchange transfusion are indicated for severe disease.
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Affiliation(s)
- Edouard Vannier
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA
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Cangelosi JJ, Sarvat B, Sarria JC, Herwaldt BL, Indrikovs AJ. Transmission ofBabesia microtiby blood transfusion in Texas. Vox Sang 2008; 95:331-4. [DOI: 10.1111/j.1423-0410.2008.01094.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hildebrandt A, Tenter AM, Straube E, Hunfeld KP. Human babesiosis in Germany: Just overlooked or truly new? Int J Med Microbiol 2008. [DOI: 10.1016/j.ijmm.2007.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Skripchenko A, Balch A, Mackin A, Wagner SJ. In vivo recovery and survival of red cells after photodynamic treatment with thiopyrylium and red light using a canine model. Vox Sang 2007; 92:157-9. [PMID: 17298580 DOI: 10.1111/j.1423-0410.2006.00864.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recently, we have shown that thiopyrylium has robust inactivation capabilities against a broad spectrum of pathogens in the human red blood cell (RBC) suspensions while retaining key RBC in vitro properties. The 24-h recovery and survival of canine red cells were measured upon autologus reinfusion of control and phototreated units. The 24-h recovery of control and phototreated RBCs was 75.7 +/- 6.4% and 87.5 +/- 8.5%, respectively. The time for 50% survival of labelled control RBCs was similar to that of phototreated group (206 +/- 58 h vs. 255 +/- 63 h, respectively). Results suggest that thiopyrylium phototreatment does not negatively affect canine RBC in vivo recovery.
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Affiliation(s)
- A Skripchenko
- Holland Laboratory for the Biomedical Sciences, American Red Cross, 15601 Crabbs Branch Way, Rockville, MD 20855, USA.
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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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Fox LM, Wingerter S, Ahmed A, Arnold A, Chou J, Rhein L, Levy O. Neonatal babesiosis: case report and review of the literature. Pediatr Infect Dis J 2006; 25:169-73. [PMID: 16462298 DOI: 10.1097/01.inf.0000195438.09628.b0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of transfusion-associated neonatal babesiosis is presented. Jaundice, hepatosplenomegaly, anemia and conjugated hyperbilirubinemia developed in this preterm infant. The diagnosis was eventually made by blood smear, serology and polymerase chain reaction. The patient was treated with clindamycin and quinine and made a favorable recovery. Of neonatal babesiosis reported in the literature, 9 other cases are reviewed, including 6 that were transfusion-associated, 2 congenital and 2 tick transmitted.
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Affiliation(s)
- Leanne M Fox
- Division of Infectious Diseases, Children's Hospital Boston, Harvard Medical School, Boston, MA.
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Wagner SJ, Skripchenko A, Donnelly DJ, Ramaswamy K, Detty MR. Chalcogenoxanthylium photosensitizers for the photodynamic purging of blood-borne viral and bacterial pathogens. Bioorg Med Chem 2005; 13:5927-35. [PMID: 16140537 DOI: 10.1016/j.bmc.2005.07.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 07/07/2005] [Accepted: 07/08/2005] [Indexed: 11/18/2022]
Abstract
Thio- and selenoxanthylium dyes were prepared by the addition of 2-lithiothiophene, 4-N,N-dimethylaminophenylmagnesium bromide, and 1-naphthylmagnesium bromide to the appropriate 2,7-bis-N,N-dimethylaminochalcogenoxanthen-9-one, followed by dehydration and ion exchange to the chloride salts. The corresponding chalcogenoxanthylium dyes were evaluated as photosensitizers for the inactivation of intracellular and extracellular virus in red blood cell suspensions and for the inactivation of selected strains of gram (+) and gram (-) bacteria in red blood cell suspensions. Selected combinations of photosensitizer and light gave >6 log10 inactivation of intracellular and extracellular virus, and >4 log10 inactivation of extracellular bacteria with varying levels of hemolyis, following a 42-day storage of red blood cell suspensions. Photocleavage experiments with plasmid DNA and the chalcogenoxanthylium dyes suggested the genomic material contained in the virus and in the bacteria as one possible target for the photodynamic action of some of these dyes.
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Affiliation(s)
- Stephen J Wagner
- American Red Cross, Holland Laboratory for the Biomedical Sciences, Rockville, MD 20855, USA
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Sopena N, Sánchez M, Merino AM. [Fever after surgical procedure in a 54 year-old male]. Med Clin (Barc) 2005; 124:710-6. [PMID: 15899167 DOI: 10.1157/13075096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Nieves Sopena
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Wagner SJ, Skripchenko A, Cincotta L, Thompson-Montgomery D, Awatefe H. Use of a flexible thiopyrylium photosensitizer and competitive inhibitor for pathogen reduction of viruses and bacteria with retention of red cell storage properties. Transfusion 2005; 45:752-60. [PMID: 15847665 DOI: 10.1111/j.1537-2995.2005.04188.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Progress in developing photochemical methods for pathogen reduction of red blood cells (RBCs) has been hampered by hemolysis. A flexible, nucleic acid-intercalating thiopyrylium (TP) dye that is only photochemically active in the bound state and a competitive inhibitor of RBC membrane binding, dipyridamole (DP), was used to reduce photoinduced hemolysis stemming from free- and membrane-bound dye. STUDY DESIGN AND METHODS Oxygenated leukodepleted 20% hct RBC suspensions were deliberately inoculated with virus or bacteria, incubated with 200 micromol per L DP and less than or equal to 100 micromol per L TP, illuminated with 1.1 J/cm(2) of red light, and titered. RBC suspensions containing 200 micromol per L DP and 160 micromol per L TP were identically phototreated, concentrated to 45% hct, and assayed for RBC storage properties. RESULTS In RBC suspensions containing DP, TP photoinactivated vesicular stomatitis virus, pseudorabies virus, duck hepatitis B virus, bovine virus diarrhea virus, extracellular human immunodeficiency virus (HIV) to the limit of detection and 6.2 log intracellular HIV. More than 5 log inactivation of 6 bacterial species was demonstrated. DP prevented approximately 30% of TP binding to RBCs. Phototreated RBCs that were subsequently stored for 42 days exhibited acceptable levels of hemolysis, morphology scores, extracellular pH, ATP, glucose utilization rates, and lactate production. Treated samples exhibited substantially increased potassium efflux compared to controls. CONCLUSION Use of TP photosensitizer and DP enables significant levels of pathogen reduction while retaining most, but not all RBC properties during 42 day storage.
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Affiliation(s)
- Stephen J Wagner
- American Red Cross Biomedical Services, Holland Laboratory, Blood and Cell Therapy Development, Rockville, Maryland, USA.
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Wardrop KJ, Reine N, Birkenheuer A, Hale A, Hohenhaus A, Crawford C, Lappin MR. Canine and feline blood donor screening for infectious disease. J Vet Intern Med 2005. [PMID: 15715062 PMCID: PMC7166425 DOI: 10.1111/j.1939-1676.2005.tb02672.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide veterinarians with guidelines regarding the pathophysiology, diagnosis, or treatment of animal diseases. The foundation of the Consensus Statement is evidence‐based medicine, but if such evidence is conflicting or lacking, the panel provides interpretive recommendations on the basis of their collective expertise. The Consensus Statement is intended to be a guide for veterinarians, but it is not a statement of standard of care or a substitute for clinical judgment. Topics of statements and panel members to draft the statements are selected by the Board of Regents with input from the general membership. A draft prepared and input from Diplomates is solicited at the Forum and via the ACVIM Web site and incorporated in a final version. This Consensus Statement was approved by the Board of Regents of the ACVIM before publication.
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Affiliation(s)
- K Jane Wardrop
- College of Veterinary Medicine, Washington State University, Pullman, WA, USA.
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Loa CC, Adelson ME, Mordechai E, Raphaelli I, Tilton RC. Serological diagnosis of human babesiosis by IgG enzyme-linked immunosorbent assay. Curr Microbiol 2005; 49:385-9. [PMID: 15696612 DOI: 10.1007/s00284-004-4373-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An enzyme-linked immunosorbent assay (ELISA) for the detection of IgG antibodies to Babesia microti antigen was developed. B. microti antigens were harvested from experimentally infected hamster blood and used as a coating antigen. The sensitivity and specificity of the IgG ELISA relative to immunofluorescent antibody assay (IFA) testing was 95.5% and 94.1%, respectively. According to the receiver operating characteristic curve analysis, the area under the curve was 0.987. No cross-reactivity of serum samples collected from patients infected with Toxoplasma gondii, Borrelia burgdorferi, Anaplasma phagocytophilum, Bartonella quintana, Dengue virus, or West Nile virus was detected. Cross-reactivity was observed with one of 35 sera from patients infected with Bartonella henselae. These results indicate that the established ELISA methods could be utilized as an accurate measure for the clinical diagnosis of human babesiosis.
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Affiliation(s)
- Chien Chang Loa
- Department of Research and Development, Medical Diagnostic Laboratories, L.L.C., Mount Laurel, NJ 08054, USA
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Abstract
Parasitic infections are felt by most individuals to have little impact on the health and well being of most inhabitants of Canada, Western Europe, and the United States. As the authors show in this article, parasites are always "emerging" somewhere and have a significant impact on those areas of the world. Moreover, as we are becoming an ever-smaller global village, catastrophes and instability in the Third World affect control of parasitic diseases endemic to those areas, ensuring greater chances of transmission to visitors there. The foundation of successful limitation of parasitic diseases in both developing and developed regions is still accurate and rapid diagnosis.
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Affiliation(s)
- John D Christie
- Department of Pathology and Laboratory Medicine, Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA.
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Wagner SJ, Skripchenko A. Investigation of photosensitizing dyes for pathogen reduction in red cell suspensions. Biotech Histochem 2004; 78:171-7. [PMID: 14714880 DOI: 10.1080/1052029032000140894] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Despite recent advances in blood safety by careful donor selection and implementation of infectious disease testing, transmission of viruses, bacteria and parasites by transfusion can still rarely occur. One approach to reduce the residual risk from currently tested pathogens and to protect against the emergence of new ones is to investigate methods for pathogen inactivation. The use of photosensitizing dyes for pathogen inactivation has been studied in both red cell and platelet blood components. Optimal properties of sensitizing dyes for use in red cell suspensions include selection of dyes that traverse cell and viral membranes, bind to nucleic acids, absorb light in the red region of the spectrum, inactivate a wide range of pathogens, produce little red cell photodamage from dye not bound to nucleic acid and do not hemolyze red cells in the dark. Early research at the American Red Cross focused on the use of a class of dyes with rigid structures, such as the phenothiazine dyes, beginning with the prototypical sensitizer methylene blue. Results revealed that methylene blue phototreatment could inactivate extracellular virus, but resulted in undesirable defects in the red cell membrane that resulted in enhanced hemolysis that became evident during extended refrigerated blood storage. In addition, methylene blue phototreatment could neither inactivate intracellular viruses nor appreciably inactivate bacteria under conditions of extracellualar viral killing. Attempts to improve intracellular viral inactivation led to the investigations of more hydrophobic phenothiazines, such as methylene violet or dimethylmethylene blue. Although these dyes could inactivate intracellular virus, problems with increased red cell membrane damage and hemolysis persisted or increased. Further studies using red cell additive storage solutions containing high levels of the impermeable ion, citrate, to protect against colloidal osmotic hemolysis as well as competitive inhibitors to limit sensitizer binding to red cell membranes revealed that photoinduced hemolysis stemmed from dye bound to the red cell membrane as well as dye free in solution. Use of red cell additive solutions to prevent colloidal-osmotic hemolysis and use of novel flexible dyes that only act as sensitizers when bound to their targets are two techniques that currently are under investigation for reducing red cell damage. Ultimately, the decision to implement a photodynamic method for pathogen reduction will be determined by weighing the risks of unintended adverse consequences of the procedure itself, such as the potential for genotoxicity and allergic reactions, against the cost and benefits of its implementation.
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Affiliation(s)
- S J Wagner
- American Red Cross, Biomedical Research and Development, Blood & Cell Therapy Development, Rockville, MD 20855, USA.
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Cable RG, Leiby DA. Risk and prevention of transfusion-transmitted babesiosis and other tick-borne diseases. Curr Opin Hematol 2004; 10:405-11. [PMID: 14564169 DOI: 10.1097/00062752-200311000-00002] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Tick-borne diseases have increasingly been recognized in the United States as public health problems. The importance of tick-borne diseases has been accelerated by increases in animal populations, as well as increased human recreation in wooded environments that are conducive to tick bites. Babesiosis, usually caused by the intraerythrocytic parasite, Babesia microti and transmitted by the same tick as Lyme disease, has important transfusion implications. Although Lyme disease has not been reported from blood transfusion, newly identified tick-borne diseases such as ehrlichiosis raise additional questions about the role of the tick in transfusion-transmitted diseases. RECENT FINDINGS The risk of transfusion-transmitted babesiosis is higher than usually appreciated and in endemic areas represents a major threat to the blood supply. Furthermore, the geographic range of B. microti is expanding, other Babesia spp. have been implicated in transfusion transmission in the western United States, and the movement of blood donors and donated blood components may result in the appearance of transfusion babesiosis in areas less familiar with these parasites. Consequently, a higher degree of clinical suspicion will allow early recognition and treatment of this important transfusion complication. SUMMARY In endemic areas transfusion-transmitted babesiosis is more prevalent than usually believed. The extension of the geographic range of various Babesia spp. and the movement of donors and blood products around the United States has resulted in the risk extending to non-endemic areas. Clinicians should maintain a high degree of clinical suspicion for transfusion-transmitted babesiosis.
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Affiliation(s)
- Ritchard G Cable
- American Red Cross, Connecticut Blood Services, Farmington, and University of Connecticut Health Center, Farmington, Connecticut 06032, USA.
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