The third described case of transfusion-transmitted Babesia duncani

Authors

  • Evan M. Bloch,

    Corresponding author
    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Barbara L. Herwaldt,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • David A. Leiby,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Annette Shaieb,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Ross M. Herron,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Michael Chervenak,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • William Reed,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Robert Hunter,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Rosilyn Ryals,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Ward Hagar,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Maniphet V. Xayavong,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Susan B. Slemenda,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Norman J. Pieniazek,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Patricia P. Wilkins,

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • Anne M. Kjemtrup

    1. From the Blood Systems Research Institute, San Francisco, California; the Centers for Disease Control and Prevention, Atlanta, Georgia; the American Red Cross Holland Laboratory, Rockville, Maryland; the Alta Bates Summit Medical Center, Berkeley, California; the American Red Cross, Southern California Region, Pomona, California; the American Red Cross, Northern California Region, Oakland, California; Cerus Corporation, Concord, California; the California Department of Public Health, Laboratory Field Services, Los Angeles, California; the Alameda County Public Health Department, Alameda, California; the Children's Hospital and Research Center at Oakland, Oakland, California; and the California Department of Public Health, Division of Communicable Disease Control, Sacramento, California.
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  • The findings and conclusions in this report are those of the authors and do not necessarily represent the policy of the Centers for Disease Control and Prevention.

Evan M. Bloch, MD, MS, Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, CA 94118; e-mail: ebloch@bloodsystems.org.

Abstract

BACKGROUND: Almost all of the reported US tick-borne and transfusion-associated Babesia cases have been caused by Babesia microti, which is endemic in the Northeast and upper Midwest. We investigated a case caused by B. duncani (formerly, the WA1-type parasite), in a 59-year-old California resident with sickle cell disease (HbSS) whose only risk factor for infection was receipt of red blood cell transfusions.

CASE REPORT: The patient's case was diagnosed in September 2008: intraerythrocytic parasites were noted on a blood smear, after a several-month history of increasing transfusion requirements. Molecular and indirect fluorescent antibody (IFA) analyses were negative for B. microti but were positive for B. duncani (IFA titer, 1:1024). The complete 18S ribosomal RNA gene of the parasite was amplified from a blood specimen; the DNA sequence was identical to the sequence for the index WA1 parasite isolated in 1991. The patient's case prompted a transfusion investigation: 34 of 38 pertinent blood donors were evaluated, none of whom tested positive by B. microti IFA. The implicated donor—a 67-year-old California resident—had a B. duncani titer of 1:4096; B. duncani also was isolated by inoculating jirds (Mongolian gerbils) with a blood specimen from March 2009, more than 10 months after his index donation in April 2008. The patient's case was diagnosed more than 4 months after the implicated transfusion in May 2008.

CONCLUSIONS: This patient had the third documented transfusion case caused by B. duncani. His case underscores the fact that babesiosis can be caused by agents not detected by molecular or serologic analyses for B. microti.

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