Wednesday, May 25, 2016

A prospective evaluation of chronic Babesia microti infection

Thu May 19, 2016 11:23 am (PDT) . Posted by: 
*A prospective evaluation of chronic /Babesia microti/ infection in 
seroreactive blood donors*
Bloch, E. M., Levin, A. E., Williamson, P. C., Cyrus, S., Shaz, B. H., 
Kessler, D., Gorlin, J., Bruhn, R., Lee, T.-H., Montalvo, L., Kamel, H. 
and Busch, M. P.
/Transfusion/, online first May 17, 2016.


/Babesia microti/ is the foremost infectious risk to the US blood supply 
for which a Food and Drug Administration (FDA)-licensed test is 
unavailable for donation screening. Characterization of the antibody 
response to /B. microti/ and correlation with parasitemia is necessary 
to guide screening and donor management policies.

During an FDA licensure trial, blood donors were prospectively screened 
(July-November 2013) using a /B. microti-/specific antibody enzyme 
immunoassay (EIA, Immunetics) in highly endemic (New York [NY]; 
n = 13,688), moderately endemic (Minnesota [MN]; n = 4583), and 
nonendemic (New Mexico [NM]; n = 8451) regions. Blood donors with 
repeat-reactive (RR) results participated in a 12-month prospective 
cohort study using /B. microti/ EIA, immunofluorescent assay, polymerase 
chain reaction (PCR), blood smear, and clinical questionnaire.

Thirty-seven (61.67%; 24 NY, seven MN, six NM) of 60 eligible RR donors 
enrolled in the study; 20 of 37 (54%) completed the 12-month follow-up 
visit of which 15 (75%) were still seroreactive. Nine PCR-positive 
donors were identified during index screening; five participated in the 
follow-up study, three were PCR positive at 6 months, and two remained 
positive at final follow-up (378 and 404 days). Most RR donors displayed 
low-level seroreactivity that was either stable or waning during 
follow-up. The level and pattern of reactivity correlated poorly with 
PCR positivity.

The findings indicate prolonged seropositivity in blood donors. Although 
rare, asymptomatic, persistent PCR positivity supports the current 
policy of indefinite deferral for donors with a history of babesiosis or 
positive test results. Repeat testing by PCR and serology will be 
necessary if reinstatement is to be considered.
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