Record number:
1054
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Despite of the high number of cases of dengue worldwide (endemic areas) there are very few, well -documented reported cases of transfusion-associated dengue transmission. Some possible explanations have been put forward, including difference in pathogenicity according to route of transmission, high seroprevalence in endemic areas.
Time to detection:
5 days
Alerting signals, symptoms, evidence of occurrence:
A 56 year old man with aplastic anaemia hospitalised in an intensive care unit with closed air-conditioning system in the city of Sao Paulo, Brazil, during a period of high dengue activity in the community. On admission D+11, he was transfused with 1 unit of apheresis platelets and on D+16 he developed high fever and hypotension. Bacteriological investigations were negative and no cause for the fever was found. Empirical broad-spectrum antibiotics given for febrile neutropenia. The platelet donor reported post-donation dengue fever (DF) five days post donation, which prompted testing of the recipient; at the onsent of symptoms the recipient's plasma viral load of 8.72E+05 copies/ml (DENV1) , with no detectable anti-dengue antibodies. A week later the patient recovered, developed an IgM response and the viral load had decreased to 6.19E+02. The other platelet unit was transfused to a lymphoma patient who was on ambulatory care (level of imunosuppression not decribed). Exact date of transfusion was not given but recipient tested negative for dengue serology and RNA around 6 and 20 days post transfusion. No symptoms suggestive of DF were detected during this period.
Demonstration of imputability or root cause:
Index donation was tested retrospectively and shown to be dengue IgM and IgG negative (Focus, Cypress, CA, USA). Undetectable dengue RNA in plasma using an in house real time PCR with a claimed lower limit of detection of 350 copies/ml. Donor seroconverted and had detectable dengue IgM and IgG on a follow up sample taken 17 days post-donation. Donor lived in a district with intense dengue activity and had other household members diagnosed with DF as well. The time from recipient's ITU admission to symptoms was 16 days (see details under alerting signals). It is believed that due to the sensitivity of the PCR used, virus could not be amplified from the index donation hence sequence comparison could not be made. The epidemiological and temporal association of events makes transfusion-associated transmission very likely, despite of the high dengue activity in the area.
Imputability grade:
2 Probable
Keywords:
Suggest references:
Levi JE, Nishiya A, Felix AC, Salles NA, Sampaio LR, Hangai F, et al. Real-time symptomatic case of transfusion-transmitted dengue. Transfusion. 2015.