The third described case of transfusion-transmitted Babesia duncani
The third described case of transfusion-transmitted Babesia duncani
复制标题
DOI：
10.1111/j.1537-2995.2011.03467.x
复制
发表时间：
2012-07-01
期刊：
影响因子：
2.9
通讯作者：
Kjemtrup, Anne M.
中科院分区：
文献类型：
--
作者：
Bloch, Evan M.;Herwaldt, Barbara L.;Kjemtrup, Anne M.
背景：几乎所有报道的美国蜱传和输血相关的巴贝斯虫病例都是由微巴贝斯虫引起的，这是东北和中西部地区的地方性疾病。我们调查了一例由B. duncani（以前是wa1型寄生虫）引起的病例，患者为59岁的加州居民，患有镰状细胞病（HbSS），其感染的唯一危险因素是接受红细胞输血。病例报告：该患者病例于2008年9月确诊：在输血需求增加几个月后，在血液涂片上发现红细胞内寄生虫。分子和间接荧光抗体（IFA）检测微螺旋体呈阴性，而邓肯螺旋体呈阳性（IFA滴度为1:1024）。从血标本中扩增出完整的18S核糖体RNA基因；DNA序列与1991年分离的WA1型寄生虫的序列相同。患者的病例促使输血调查：对38名相关献血者中的34人进行了评估，其中没有一人的微螺旋体IFA检测呈阳性。受牵连的捐赠者67岁的加州居民，邓肯氏杆菌滴度为1:4096；在2008年4月首次献血10个多月后的2009年3月，通过接种贾伊德（蒙古沙鼠）的血液样本也分离出了B. duncani。该病例是在2008年5月输血后4个多月确诊的。结论：该患者是记录在案的第三例由邓肯杆菌引起的输血病例。他的病例强调了这样一个事实，即巴贝斯虫病可能是由微贝氏杆菌分子或血清学分析未检测到的病原体引起的。
BACKGROUND: Almost all of the reported US tick-borne and transfusion-associated Babesia cases have been caused by Babesia microti, which is endemic in the Northeast and upper Midwest. We investigated a case caused by B. duncani (formerly, the WA1-type parasite), in a 59-year-old California resident with sickle cell disease (HbSS) whose only risk factor for infection was receipt of red blood cell transfusions. CASE REPORT: The patient's case was diagnosed in September 2008: intraerythrocytic parasites were noted on a blood smear, after a several-month history of increasing transfusion requirements. Molecular and indirect fluorescent antibody (IFA) analyses were negative for B. microti but were positive for B. duncani (IFA titer, 1:1024). The complete 18S ribosomal RNA gene of the parasite was amplified from a blood specimen; the DNA sequence was identical to the sequence for the index WA1 parasite isolated in 1991. The patient's case prompted a transfusion investigation: 34 of 38 pertinent blood donors were evaluated, none of whom tested positive by B. microti IFA. The implicated donora 67-year-old California residenthad a B. duncani titer of 1:4096; B. duncani also was isolated by inoculating jirds (Mongolian gerbils) with a blood specimen from March 2009, more than 10 months after his index donation in April 2008. The patient's case was diagnosed more than 4 months after the implicated transfusion in May 2008. CONCLUSIONS: This patient had the third documented transfusion case caused by B. duncani. His case underscores the fact that babesiosis can be caused by agents not detected by molecular or serologic analyses for B. microti.