Vaso‐occlusive crisis in a sickle cell patient after transfusion‐transmitted dengue infection

Abstract

Case Report A 26‐year‐old woman with sickle cell disease (SCD) on chronic transfusion therapy complained of severe arthralgia, myalgia, abdominal pain, headache, and fever 24 hours after transfusion of a red blood cells (RBCs). Dengue virus (DENV) infection was suspected and the patient was hospitalized for clinical support and RBC transfusion, to lower the hemoglobin S to less than 30%. The patientʼs clinical condition improved approximately 8 days after the onset of symptoms. Results DENV type 2 (DENV‐2) TaqMan real‐time polymerase chain reaction was negative in the patient's pretransfusion sample while the posttransfusion sample was positive (Ct, 27.8), suggesting a high viral load and an acute infection. To investigate DENV transfusion transmission (TT‐DENV) the stored donor serum was tested and was also positive (Ct, 25.8). Molecular typing confirmed the presence of DENV‐2. The phylogenetic analysis of the DENV‐2 strains obtained from both donor and patient samples were classified as the Southeast Asia‐American genotype (Genotype III) and demonstrated 100% genomic identity, indicating TT‐DENV. Conclusion This is the first description of TT‐DENV in a SCD patient. A presumed high viral load in the transfused RBC unit probably determined the early clinical manifestation. In endemic regions dengue fever should be considered as differential diagnosis in SCD patients with fever and acute pain crisis, mainly during DENV outbreaks.

Dengue RNA detection and seroprevalence in blood donors during an outbreak in the São Paulo State, Brazil, 2016

“…However, it stresses the importance of implementation of other strategies, such as donor education, during DENV outbreaks as more accessible (even less specific) measures to prevent TT‐DENV. Nevertheless, a recent case of TT‐DENV in a patient with sickle cell disease leading to severe outcome 21 and the possibility of silent DENV circulation independent of outbreaks 6 stress the importance of DENV in transfusion medicine and that more efficient measures are required to prevent TT‐DENV.…”

Viral Metagenomics for Identification of Emerging Viruses in Transfusion Medicine

“…During large outbreaks, asymptomatically DENV-infected blood donors might be a cause for contamination of donated blood products [12,13]. Clinical complications due to transfusion-transmitted DENV, especially in patients with underlying diseases have also been reported [14][15][16]. Transfusion-transmission of other arboviruses related to clinical consequences were reported for the Japanese encephalitis virus (JEV), where the blood recipient developed severe encephalitis and death [17] and for Ross River virus, where the transfusion-transmission was related to a symptomatic infection [18].…”

Comparative metavirome analysis in polytransfused patients

“…Nevertheless, there is always the risk of residual transmission due to factors including extremely high viral loads, mutations in the target sequence, and window period testing in which infection markers are undetectable ( 5 ). Apart from this, virtually any virus that establishes viremia is transmissible by blood transfusion including even exotic viral agents like those normally transmitted by arthropods such as Japanese encephalitis ( 6 ), Dengue ( 7 ), and the Powassan virus ( 8 ), of which transfusion transmission has also been documented and may equally affect polytransfused patients.…”