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Letter to Editor
A case of bacterial infection due to red blood cell unit
1 Centro Hospitalar de Setubal, Nephrology Department, Setúbal, Portugal
Address correspondence to:
Elsa Soares
Rua Camilo Castelo Branco, 2910-449 Setúbal,
Portugal
Message to Corresponding Author
Article ID: 100011I03ES2019
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How to cite this article
Soares E, Valério P, Abrantes C, Farinha A, Natário A. A case of bacterial infection due to red blood cell unit. Edorium J Infect Dis 2019;5:100011I03ES2019.ABSTRACT
No Abstract
Keywords: Bacterial sepsis, Blood cell units, Infection, Yersinia enterocolitica
To the Editors,
Yersinia enterocolitica is a gram-negative bacillus of the Enterobacteriacea family. Spread of infection from source to humans may occur via contaminated water or food or directly from a blood transfusion. Resulting infection can range from gastroenteritis to septicemia, including metastatic infection [1].
An 85-year-old man with history of end-stage renal disease (with a tuneled catheter as vascular access), prostate cancer, and diabetes mellitus, was referred to the emergency department (ED) after a hemodialysis session due to hemoglobin (Hb) value 6.7 g/dL. He did a unit of red blood concentration (RBC) and was discharged. A few hours later he was malaise and febrile, but went to the ED only five days later. At admission, he was febrile (39.6°C) and hypotensive (94–47 mmHg). Laboratory results identified Hb 7.6 g/dL; leukocytes 13,200/ul, neutrophils 86.6%, C-reactive protein (CRP) 28 mg/dL, normal urinary sediment, and no alteration on chest X-ray. As the patient did not have any apparent source of infection, it was assumed a catheter-related infection. It was removed and initiated vancomycin and gentamicin.
On the fifth day of antibiotic, Y. enterocolitica was identified at the catheter and on peripheral blood cultures. We interrupted vancomycin and started ciprofloxacin according to the antibiotic sensitivity test.
The case was reported to the blood service, this is performed whenever there is a suspected complication. The RBC donor was called and the study showed the presence of high titters (200) of anti-Yersinia antibodies from the same isolate strain measured by indirect immunofluorescence. The patient completed 21 days of antibiotic therapy with good clinical evolution. It is a case of post-transfusional bacterial sepsis that had a favorable outcome, unlike most cases described in the literature. Due to its psychotropic action, Y. enterocolitica is not inhibited by the storage temperatures off blood (2–6°C) [2]. Bacterial multiplication is supported both for glucose and adenine of the anticoagulant preparative and additive solution and by the hemoglobin and iron resulting from cell lysis over the shelf life [3].
Systematic screening of blood donations for the presence of blood-borne viruses has resulted in an important decrease of viral infections [4], and bacterial sepsis has become the most frequent infectious complication of transfusion in developed countries [5].
Yersinia enterocolitica is associated with ~46% of documented cases of clinical sepsis from a contaminated RBC; nevertheless, this is an infrequent event. The screening of Yersinia infection in red blood cell units is the only way to avoid the blood donor transmission. Unfortunately it is too expensive, thus not cost effective, so it is up to the clinician to avoid transfusions and decrease the risk.
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Guinet F, Carniel E, Leclercq A. Transfusion-transmitted Yersinia enterocolitica sepsis. Clin Infect Dis 2011;53(6):583–91. [CrossRef]
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SUPPORTING INFORMATION
Author Contributions
Elsa Soares - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Patricia Valério - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Catarina Abrantes - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ana Farinha - Conception of the work, Design of the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ana Natário - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Elsa Soares et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
