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Ready to upload
Record number:
1842
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Bartonella bacilliformis infection is a rare disease, although there are endemic areas in South American countries (the Andean regions of northern Peru, southern Ecuador and southern Colombia). PCR testing found a point prevalence of asymptomatic individuals with bacteraemia in a Peruvian endemic area of 0.5%, with a seroprevalence of 45% and an incidence of 12.7/100 person-years (Chamberlin J, Laughlin L, Gordon S, Romero S, Solórzano N, Regnery R. Serodiagnosis of Bartonella bacilliformis infection by indirect fluorescent antibody assay: test development and application to a population in an area of endemic bartonellosis, J Clin Microbiol, 2000, vol 38 (pp 4269-71)). Very few cases of suspected transfusion-transmitted bartonellosis have been published.
Time to detection:
The first clinical signs of infection were reported 21 days (day 117 from first admission) after transfusion of contaminated platelets. Five days later, 26 days (122 days from the first admission) after the contaminated platelet transfusion, the patient's condition worsened and PCR testing of the blood sample showed the presence of Bartonella bacilliformis in the blood.
Alerting signals, symptoms, evidence of occurrence:
On day 96 of the first admission, the patient received a transfusion of platelets that were contaminated with B. bacilliformis. After 21 days, on day 117 after the first visit, the patient presented to the emergency department with anaemia, fever (38.8 °C), acute bloody diarrhoea, pallor, jaundice, and splenomegaly, treated with ceftriaxone (2 g/day) and additional transfusions of erythrocytes and platelets. After five days (day 122), 26 days after the transfusion of contaminated platelets, the condition worsened with increased generalised oedema, dyspnoea, liver dysfunction, and signs of haemolysis. At this time, PCR testing of a blood sample showed B. bacilliformis and he was treated for the newly diagnosed acute severe haemolysis and organ dysfunction phase of newly acquired Bartonellosis, also known as Oroya fever or Carrión disease. The patient was successfully treated with the parenteral antibiotic therapy.
Demonstration of imputability or root cause:
The bacterium B. Baciliformis, which caused illness in the transfusion recipient, was present in the patient's blood and in the blood sample of donation from which the transfused platelets were prepared. The time elapsed from transfusion to emergency department visit (21 days) was compatible with the incubation period. The presence of bacteria in the patient's blood was proven by PCR testing. The nature of the platelet preparation (single-donor apheresis or obtained from whole blood and then pooled) is not stated, nor is the type of test used to determine the presence of B. bacilliformis. There was no sequencing of the bacteria present in the donated blood platelets and the patient's blood to document the identity of the nucleotide sequences and a possible natural infection through a sandfly bite could not be ruled out. Additional information on the presence of bacteria in the involved donor and information on the look-back procedure was not provided in the report.
Imputability grade:
2 Probable
Groups audience:
Keywords:
References:
Suggest new keywords:
Carrion's disease, Bartonella bacilliformis
Reference attachment:
Suggest references:
Maria J. Pons, et al. Carrion's disease after blood transfusion. Blood Transfus 2016; 14: 527-30
Expert comments for publication:
This is a case of probable transfusion-transmitted Bartonella bacilliformis infection in 47 years old male patient with chronic myeloid leukaemia from Cajamarca in the Andean region of northern Peru, who developed clinical symptoms of fever, acute severe haemolysis and organ dysfunction phase of newly acquired Bartonellosis, also known as Oroya fever or Carrión disease. The presence of B. bacilliformis in both the patient's blood and the transfused platelets, as well as the development of clinical symptoms within the incubation period typical of Oroya fever, indicates a probable case of B. bacilliformis infection associated with platelet transfusion, as there was no sequencing of the bacteria present in the donated blood platelets and the patient's blood to document the identity of the nucleotide sequences. A possible natural infection through a sandfly bite could not be ruled out. Additional information on the presence of bacteria in the involved donor and information on the look-back procedure was not provided in the report.