Yersinia enterocolitica Bacteremia and Endotoxin Shock Associated
with Red Blood Cell Transfusion -- United States, 1987-1988
Four cases of Yersinia enterocolitica bacteremia associated with
packed red blood cell (PRBC) transfusions were reported from April
1987
through August 1988. All case- patients developed chills, fever,
hypotension, and at least one of the following: renal failure,
respiratory failure, and/or coagulopathy. Two patients died. All
case-patients developed symptoms while receiving PRBCs that had
been
stored at 4 C for 26-42 days. Patient blood cultures and residual
RBCs
from each blood bag grew Y. enterocolitica, serotype O:3 (three
cases)
or O:1,2,3 (one). Of the three case- patients for whom
investigations
have been completed, two donors had histories of gastrointestinal
illness during the 2 weeks before donation of the implicated units
of
blood; results of serologic studies were compatible with recent
Yersinia sp. infection in the two donors. The third donor was
asymptomatic.
Reported by: JP Davis, MD, State Epidemiologist, Wisconsin Dept of
Health and Social Svcs. M Moser, MD, State Epidemiologist, Kentucky
Dept of Health Svcs. RH Hutcheson, MD, State Epidemiologist,
Tennessee
Dept of Health and Environment. TG Betz, MD, State Epidemiologist,
Texas Dept of Health. MH Wilder, MD, State Epidemiologist, Florida
Dept
of Health and Rehabilitative Svcs. LA Wintermeyer, MD, State
Epidemiologist, Iowa Dept of Health. BJ Francis, MD, State
Epidemiologist, Illinois Dept of Public Health. HD Donnell Jr, MD,
State Epidemiologist, Missouri Dept of Health. Office of
Compliance,
Center for Biologics Evaluation and Research, Food and Drug
Administration. Div of Bacterial Diseases and Hospital Infections
Program, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Bacteremia is a rare complication of blood
transfusion but should be considered in any severe unexplained
transfusion reaction. The incidence of Y. enterocolitica bacteremia
associated with blood transfusion is unknown. However, before 1987,
only six cases had been reported in the world literature, and only
one
of these occurred in the United States (1-6). In vitro studies have
shown that after a lag period of 2-3 weeks, small inocula (less
than 1
CFU/mL) of Y. enterocolitica can proliferate to high titers
(greater
than 108 CFU/mL) and produce large amounts of endotoxin in RBCs
stored
at 4 C without hemolysis or other visible changes in the RBCs (CDC,
unpublished data). No information on Y. enterocolitica serostatus
in
blood donors is available.
If transfusion-associated sepsis is suspected, both the
recipient's
blood and the residual blood in the transfusion bag should be
cultured.
The blood bag, administration tubing, and any bacterial isolates
from
the recipient and the blood should be saved until the investigation
is
complete. So that the frequency of transfusion- associated Y.
enterocolitica sepsis can be estimated, physicians are requested to
report cases through state health departments to the Epidemiology
Branch, Hospital Infections Program, Center for Infectious
Diseases,
CDC; telephone: (404) 639-3406.
References
Stenhouse MAE, Milner LV. Yersinia enterocolitica: a hazard in
blood transfusion. Transfusion 1982;22:396-8.
Schmitt JL, Bataille P, Coevoet B, et al. Yersinia
enterocolitica
with shock, renal-failure and fatal lesional pulmonary-edema after
transfusion in the postpartum. Med Maladies Infect 1983;13:197-9.
Bjune G, Ruud TE, Eng J. Bacterial shock due to transfusion with
Yersinia enterocolitica infected blood. Scand J Infect Dis
1984;16:411-2.
Wright DC, Selss IF, Vinton KJ, Pierce RN. Fatal Yersinia
enterocolitica sepsis after blood transfusion. Arch Pathol Lab Med
1985;109:1040-2.
Collins PS, Salander JM, Youkey JR, et al. Fatal sepsis from
blood
contaminated with Yersinia enterocolitica: a case report. Milit Med
1985;150:689-92.
Galloway SJ, Jones PD. Transfusion acquired Yersinia
enterocolitica.
Aust NZ J Med 1986;16:248.
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