Transfusion-transmitted babesiosis popping up in more States in USA

Babesia, a severe, potentially life threatening illness, has been identified in as many as 40% of individuals with Lyme disease in the North Eastern USA. The clinical spectrum now includes what has been described as “asymptomatic.” This is particularly concerning given that the infection can be acquired not only through a tick bite but through blood transfusions.

Transfusion-transmitted babesiosis (TTB) cases have been reported in Maryland, South Carolina, and Nebraska and “serve as a reminder of the potential for TTB, especially in states not endemic for Babesia,” cautions LeBel II from the Department of Pathology and Laboratory Medicine at the Medical University of South Carolina.

In their article published in the journal Transfusion, LeBel II and colleagues report details on two cases of TTB, one in which a patient was asymptomatic and both lived in non-endemic regions (South Carolina and Maryland). Their case report highlights the difficulties identifying Babesia in the blood supply by simply tracing the donors.

“The donor implicated in Cases 2 and 3 was a 30-year-old man residing in Maryland who denied any tick exposure; however, he had a history of Lyme disease and reported owning two dogs and traveling to coastal areas in Massachusetts, New York, Connecticut, Maryland, and Virginia in the past 2 years.” This donor was positive by IFA and PCR 106 and 239 days after collection of implicated transfusions for case 2 and 3 respectively. [1]

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These “asymptomatic” individuals challenge doctors in non-endemic states in the US. “Healthy, asymptomatic individuals and individuals without knowledge of babesiosis are at the highest risk for donating contaminated blood products,” LeBel II points out.

Universal screening of all donations in the United States has not been found to be cost effective, according to the authors. So, the risk of transfusion-transmitted babesiosis is expected to be reduced by screening blood in endemic states.  However, this may not be effective. “Blood products collected in Babesia endemic areas are distributed nationally thus, clinicians in non-endemic states may fail to include babesiosis in the differential diagnosis of a patient who had a recent transfusion history and a fever of unknown origin,” LeBel II explains.

The article highlights the limitations of the questionnaire blood banks provide to donors:  “Donor History Questionnaire assesses for babesiosis using the following question: “Have you ever had babesiosis?”

Related articles:

Babesia cases skyrocket in Wisconsin with a 26-fold increase

Study raises concerns for Babesia patients and blood banks

Babesia and Lyme: It’s worse than you think

References:

1. LeBel DP, 2nd, Moritz ED, O’Brien JJ, et al. Cases of transfusion-transmitted babesiosis occurring in nonendemic areas: a diagnostic dilemma. Transfusion. 2017.