Autoimmunity in transfusion babesiosis
By Linda on Sep 17, 2010 in Infections | comments(0)
Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20824620&retmode=ref&cmd=prlinks
Excerpt:
Transfusion-acquired babesiosis can be an asymptomatic or
self-limited febrile hemolytic illness in a healthy host. A
persistent, relapsing, and/or fulminant course with the
development of life-threatening complications may be seen in
immunocompromised or splenectomized patients. As in malaria,
erythrocyte parasitemia is often associated with nonimmune
hemolysis, and can be treated with erythrocytapheresis. Just as
warm autoantibodies have been reported in malaria infection, the
development of autoantibody-mediated immune hemolysis has been
reported in babesiosis. We treated a previously healthy male with
multiple injuries from a motor vehicle accident necessitating
massive transfusion. Late in the hospitalization, his blood smear
revealed Babesia microti, confirmed by PCR study and serology.
This was eventually traced to a unit of blood from an
asymptomatic blood donor that was transfused during his initial
trauma care.
Specific antibiotic therapy was begun, and severe hemolysis from
a high parasite burden required red blood cell exchange which led
to rapid abatement of the hemolysis. He had a positive DAT (IgG
with a pan-reactive eluate) but no serum autoantibody. This
persisted for 10 days following cessation of hemolysis, and
became negative while still on antibiotics while his parasite
burden became undetectable. Reports of autoimmunity associated
with community acquired babesiosis often have severe hemolysis
from their autoantibodies, but our case shows that autoantibodies
may also follow transfusion-acquired babesiosis. The nature of
the autoantigen is unknown. J. Clin. Apheresis, 2010. (c) 2010
Wiley-Liss, Inc.
