Department of Pathology and the Department of Medicine, Christiana Care Health System, Newark, Delaware 19718, USA.
Transfusion. 2009 Dec;49(12):2583-7. doi: 10.1111/j.1537-2995.2009.02454.x. Epub 2009 Nov 9.
Most cases of human babesiosis in North America are caused by Babesia microti, which is endemic in the northeastern and upper midwestern United States. Although the disease is usually transmitted by a tick bite, there has been an increase in the number of transfusion-transmitted cases reported. We describe a fatal case of transfusion-transmitted babesiosis in a nonendemic state, Delaware.
The patient was a 43-year-old Caucasian woman with history of transfusion-dependent Diamond-Blackfan syndrome, hepatitis C, and splenectomy. She was admitted initially for presumptive pneumonia. The next day, a routine examination of the peripheral blood smears revealed numerous intraerythrocytic ring forms, consistent with Babesia. The parasitemia was approximately 5% to 6%. The diagnosis was confirmed by positive polymerase chain reaction (PCR) for B. microti DNA and high titer of antibody to B. microti (1:2048). Despite aggressive therapy including clindamycin and quinine antibiotics, the patient expired 3 days after admission. Subsequently, 13 blood donors were tested for B. microti. All tested donors were negative by PCR. However, one donor living in New Jersey had a significant elevated B. microti antibody titer (1:1024).
We believe that this is the first reported case of transfusion-transmitted babesiosis in Delaware, a nonendemic state. Our case illustrates that clinicians should consider babesiosis in the differential diagnosis of immunocompromised patients who have fever and recent transfusion history, even in areas where babesiosis is not endemic. It also demonstrates the need for better preventive strategies including more sensitive, specific, and rapid blood donor screening tests to prevent transfusion-transmitted babesiosis.
北美的大多数人类巴贝斯虫病是由贝氏巴贝斯虫引起的，该虫在美国东北部和中西部地区流行。尽管这种疾病通常是通过蜱叮咬传播的，但报告的输血传播病例数量有所增加。我们描述了一例在非流行地区特拉华州发生的输血传播巴贝斯虫病致死病例。
患者为 43 岁白人妇女，患有输血依赖性 Diamond-Blackfan 综合征、丙型肝炎和脾切除术。她最初因疑似肺炎入院。第二天，对外周血涂片的常规检查显示存在大量红细胞内环型，符合巴贝斯虫。寄生虫血症约为 5%至 6%。通过 B. microti DNA 的聚合酶链反应（PCR）阳性和 B. microti 抗体高滴度（1:2048）确诊。尽管采用了包括克林霉素和奎宁抗生素在内的积极治疗，但患者在入院后 3 天死亡。随后，对 13 名献血者进行了 B. microti 检测。所有受检献血者的 PCR 均为阴性。然而，一名居住在新泽西州的献血者的 B. microti 抗体滴度显著升高（1:1024）。
我们认为这是特拉华州首例报告的非流行地区输血传播巴贝斯虫病病例。我们的病例表明，即使在巴贝斯虫病非流行地区，临床医生也应考虑将巴贝斯虫病纳入免疫功能低下患者发热和近期输血史的鉴别诊断中。这也表明需要更好的预防策略，包括更敏感、特异和快速的献血者筛查试验，以预防输血传播巴贝斯虫病。
