Transfusion-associated acute Chagas disease acquired in the United States

Article Abstract:

Infection by the protozoan Trypanosoma cruzi is common in Latin America but not in the United States. Immunocompromised individuals are especially vulnerable to this infection. A case is described of severe Chagas disease, or Trypanosomiasis, in an 11-year-old child with Hodgkin disease. The child had never travelled to an endemic area and the infection was eventually traced to a transfusion of platelets the patient had received. The blood donor was an asymptomatic Bolivian immigrant with chronic T. cruzi infection. The patient, who had been in remission from Hodgkin for almost one year after a splenectomy, radiotherapy and chemotherapy treatments, experienced fever and abnormal blood counts. Chemotherapy was resumed and a bone marrow biopsy was performed. The patient's condition continued to deteriorate and he developed fever, a drop in blood pressure, mild cardiac failure and tremors. A peripheral blood smear was taken which revealed T. cruzi and therapy with nifurtimox at a dose of 25 mg per kg body weight was begun. The child continued to worsen and he was given interferon-gamma. A positive reaction was observed on day seven, and after 20 days of interferon-gamma, along with 120 days of nifurtimox therapy, the patient had improved and all blood smears for the parasite were negative. The blood products the patient had previously received were traced to the donors, and one of the five that were located tested positive for T. cruzi. This case illustrates the importance of careful blood donor screening and it is suggested that better policies for identifying infected blood may be necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Is Trypanosoma cruzi a new threat to our blood supply?

Article Abstract:

Two cases of Chagas disease, an infection caused by the protozoan Trypanosoma cruzi, are described in the November 11, 1989 Annals of Internal Medicine. Both of these cases, which occurred in North America, resulted from a blood transfusion. T. cruzi infection is considered an 'exotic' disease, occurring primarily in poor underdeveloped countries, where it is a leading cause of sickness and death; it is rare in industrialized nations. The heavy influx of Latin American immigrants into the United States may have serious negative effects upon the blood supply. The risk of transmission from blood contaminated by T. cruzi in Latin American countries is between 13 and 23 percent per unit. Because many individuals who are chronically infected with T. cruzi have no symptoms, the possibility of the spread of this disease through blood transfusions from infected donors is significant. T. cruzi infections almost always cause illness and may result in death, especially in immunocompromized patients who, ironically, are among the most likely to require blood transfusions. Drug treatment for this parasitic infection is available but is still problematic, and infected individuals may have relapses. Some guidelines for the containment of this infectious disease are recommended. It is suggested that programs be instituted as soon as possible to screen for this protozoa and to assess the degree of contamination of current blood supplies in this country. In addition, no new blood donations by individuals from areas endemic for Chagas diseases should be accepted. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Blood-borne diseases, Bloodborne diseases, column

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Transfusion-associated Trypanosoma cruzi infection in a non-endemic area

Article Abstract:

A case history of a 21-year-old woman who had received treatment for acute lymphoblastic leukemia and protein S deficiency is presented. The patient was a Cree Indian who resided in Manitoba. After chemotherapy treatment the patient suffered depressed blood counts, and supplemental blood transfusions were required. After about two weeks, the patient exhibited a variety of symptoms, including neutropenia (a reduction in the level of neutrophils, a type of white blood cell), fever and congestive heart failure. During a blood test which assessed the leukocyte differential, flagellates were detected and Trypanosoma cruzi was identified. This is a protozoan blood infection that causes Chagas' disease. It is common in Latin American but not usually observed in North America. After treatment for five days with nifurtimox at a dose of 10 mg per kg body weight, the patient showed significant improvement. Because this parasite is not endemic to Manitoba and the patient had not been outside the area, a blood transfusion was suspected as the source of this infection. Because patients receiving chemotherapy often suffer from depressed levels of blood components, transfusions are often necessary. These patients are also immunocompromised and therefore extremely vulnerable to infection. Nifurtimox is recommended as the standard therapeutic treatment of T. cruzi infection, although some side effects may occur. Careful blood screening is suggested; special attention should be given to blood donations from individuals native to Latin America. (Consumer Summary produced by Reliance Medical Information, Inc.)

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