Sepsis associated with transfusion of red cells contaminated with Yersinia enterocolitica

Abstract

Between April 1987 and May 1989, the Centers for Disease Control investigated seven cases of transfusion-associated Yersinia enterocolitica sepsis; four were caused by organisms of serotype O:3, and one each was caused by organisms of serotype O:1,2,3; O:5,27; and O:20. All seven recipients developed septic shock after receiving units of red cells (RBCs) contaminated with Y. enterocolitica; five recipients died. The cases occurred in seven states and were unrelated. There was no evidence for contamination of the RBC units during processing. Six of the seven donors had serologic evidence of recent Y. enterocolitica infection, and it is hypothesized that these donors had asymptomatic bacteremia when they donated the implicated blood. Four of the seven donors reported gastrointestinal illness in the 4 weeks before blood donation, and one donor became ill on the day he donated blood. Y. enterocolitica grows well at 4 degrees C and in the presence of dextrose and iron. If blood is contaminated at the time of collection, storage of the RBCs at 4 degrees C provides an ideal environment for bacterial growth and endotoxin production. These cases demonstrate the need for careful evaluation of patients with transfusion reactions for possible sepsis and suggest a need to screen prospective blood donors for mild gastrointestinal illness, including those illnesses not requiring physician evaluation or medication.

Transfusion-related bacterial sepsis

“…These results suggest that questions of this nature may screen out an unacceptable number of healthy donors. Furthermore, onethird of donors who transmitted Y enterocolitica did not observe gastrointestinal symptoms (73,142).…”

“…Individuals infected with Y enterocolitica are typically asymptomatic at the time of blood donation (1,142). In one study, approximately two-thirds of donors implicated in Yersinia transmission later recalled gastrointestinal illness prior to donation (32,152); most of these individuals reported mild or moderate rather than severe diarrhea (73) that occurred 8 to 30 days prior to donation (142).…”

“…In one study, approximately two-thirds of donors implicated in Yersinia transmission later recalled gastrointestinal illness prior to donation (32,152); most of these individuals reported mild or moderate rather than severe diarrhea (73) that occurred 8 to 30 days prior to donation (142). Tipple and coworkers demonstrated that one infected donor, who was seronegative at the time of donation, had detectable Y enterocolitica-specific antibody 52 days postdonation (142). This information and the timing of diarrhea symptoms relative to the date of donation suggest that infected donors develop Y enterocoliticaspecific antibody several weeks after donating the contaminated unit.…”

“…A survey of these methods along with their respective bacterial contamination rates of platelet components is given in (56), which can invade the intestinal mucosa and become blood borne (30,56). Asymptomatic individuals can either exhibit no prior symptoms or harbor low-level blood infections for several weeks after symptoms of gastroenteritis have subsided (1,142). In a somewhat unusual case, an outbreak of transfusion-acquired Salmonella cholerae-suis septicemia was traced to a plasmapheresis donor who, unknowingly, had Salmonella osteomyelitis of the tibia with low-grade bacteremia (112).…”

Reduction of Platelet Transfusion– Associated Sepsis by Short–Term Bacterial Culture

“…But transfusion–associated sepsis still causes significant mortality and morbidity. Since the implementation of effective programs for reducing contamination by blood–borne viruses [3, 4, 5, 6, 7], sepsis now constitutes the major hazard of blood transfusion. Data from mandatory reporting in the United States indicate that 29 transfusion–related deaths between 1986 and 1991 were from bacterial contamination.…”