SERONEGATIVE ARTHRITIS ASSOCIATED WITH SEROLOGICAL EVIDENCE OF YERSINIA INFECTION IN AUSTRALIA

Infection due to yersinia enterocolitica is a common antecedent illness in patients with reactive arthritis in Scandinavia, but appears to be less frequent in other countries. In order to examine the frequency of yersinia infection in patients with seronegative arthritis in Australia we examined 22 patients, 15 with ankylosing spondylitis (AS) and seven with Reiter's syndrome (RS). A sensitive ELISA assay was used to detect serum antibodies to the most common serotypes. Six patients (29%) had positive yersinia serology, all were HLA B27 and four had a history of diarrhea preceding the onset of their disease. Four patients with positive yersinia serology had AS and two had RS. Antibodies were directed against Y. enterocolitica biotype 0:3 in three cases, Y. enterocolitica 0:9 in two cases and Y. enterocolitica 0:8 in one subject. Twenty-nine control subjects (13 HLA B27) had no serum antibodies to yersinia. The results of this study indicate that preceding yersinia infection occurs in a significant (p < 0.05; compared to controls) proportion of patients with HLA B27 related seronegative arthropathies.     

Risk and prevention of transfusion-transmitted babesiosis and other tick-borne diseases

PURPOSE OF REVIEW: Tick-borne diseases have increasingly been recognized in the United States as public health problems. The importance of tick-borne diseases has been accelerated by increases in animal populations, as well as increased human recreation in wooded environments that are conducive to tick bites. Babesiosis, usually caused by the intraerythrocytic parasite, Babesia microti and transmitted by the same tick as Lyme disease, has important transfusion implications. Although Lyme disease has not been reported from blood transfusion, newly identified tick-borne diseases such as ehrlichiosis raise additional questions about the role of the tick in transfusion-transmitted diseases. RECENT FINDINGS: The risk of transfusion-transmitted babesiosis is higher than usually appreciated and in endemic areas represents a major threat to the blood supply. Furthermore, the geographic range of B. microti is expanding, other Babesia spp. have been implicated in transfusion transmission in the western United States, and the movement of blood donors and donated blood components may result in the appearance of transfusion babesiosis in areas less familiar with these parasites. Consequently, a higher degree of clinical suspicion will allow early recognition and treatment of this important transfusion complication. SUMMARY: In endemic areas transfusion-transmitted babesiosis is more prevalent than usually believed. The extension of the geographic range of various Babesia spp. and the movement of donors and blood products around the United States has resulted in the risk extending to non-endemic areas. Clinicians should maintain a high degree of clinical suspicion for transfusion-transmitted babesiosis.     

Transmission of HTLV-II via Blood Transfusion

Transmission of HTLV-I by transfusion is well documented in Japan, where HTLV-I is endemic. In non endemic regions such as the United States, HTLV-I/II infection has been transmitted by transfusion as well, but no effort to distinguish HTLV-I from HTLV-II infection was made in these studies. There is a growing body of evidence that a substantial proportion of HTLV-I/II seropositivity in the US is due to infection with HTLV-II. We report 2 cases of apparent transfusion-transmitted HTLV-II infection and discuss the importance of distinguishing between the two viruses in blood donors and recipients.     

Vector-borne illnesses and the safety of the blood supply

The protection of patients from diseases carried in blood transfusions is an ongoing effort. The viruses that cause long-term human infection and death have received much of the attention in the United States and testing has significantly diminished the risk of infection from a transfusion. As the risk of these diseases has decreased, other transfusion-transmitted organisms with a lower incidence in the community or newer diseases with rapidly expanding endemic areas are receiving additional attention. One group of these infections are infections in which the normal route of human infection is a vector.     

Fatal Yersinia enterocolitica (Serotype 0:5,27) Sepsis after Blood Transfusion

Septicemia is a rare complication of blood transfusion. This is probably primarily due to the use of sealed disposable containers for blood collection and the storage of red cell-containing components at 4 degrees C. However, despite these measures, septicemia due to blood transfusion continues to occur. We report here a fatal case of Yersinia enterocolitica septicemia due to a contaminated unit of red cells which was collected from an apparently healthy, asymptomatic blood donor. The organism grows at cold temperature and multiplies during storage of red blood cell-containing components. Contaminated components do not show any visible abnormalities. The possibility of transfusion-transmitted Y. enterocolitica should be considered in patients who have symptoms of sepsis or shock following transfusion.     

Survey of current practice for prevention of transfusion-transmitted cytomegalovirus in the United States: leucoreduction vs. cytomegalovirus-seronegative

Background and Objectives  Cytomegalovirus (CMV) is a significant pathogen transmissible through blood transfusion that can have devastating effects on immunocompromised patients. Current transfusion practice provides two choices for transfusion of cellular blood components that reduce the risk of transfusion-transmitted CMV (TT-CMV): blood components collected from CMV seronegative donors and leucocyte-reduced (LR) blood components.
Materials and Methods  A web-based survey was designed and administered to AABB physician members in April 2007 to collect information regarding current blood banking and clinical practices for prevention of TT-CMV in the United States.
Results  Individuals representing 183 different institutions completed the entire survey (an institutional response rate of 32.5%). Sixty-five percent of respondents indicated that their institution considered that CMV-seronegative and LR products are equally effective in preventing TT-CMV. When analyzed by institutional type, academic institutions and community hospitals were more likely to subscribe to the premise that LR blood components are equally effective at preventing TT-CMV, than were community blood centres and government institutions. However, reported practices for specific patient populations did not match this view of equivalence between CMV-seronegative and LR products with many patient populations preferentially receiving CMV-seronegative components. Fetal and neonatal populations were more likely than other patient populations to receive CMV-seronegative products to reduce the risk of TT-CMV.
Conclusion  There is wide variability in transfusion practices to reduce the risk of TT-CMV. Lack of a consensus approach may reflect the conflicting data that exist in the literature as well as adherence to longstanding practice.     

Risk of Yersinia infection among butchers

The purpose of this study was to evaluate the risk of yersinia infection among butchers. Serum samples were collected from 146 abattoir workers, stratified into 3 groups according to exposure to swine throats and intestines. 100 healthy blood donors were used as controls. Antibodies against Yersinia enterocolitica O:3 and O:9 and Y. pseudotuberculosis I and III were measured using ELISA. Symptoms associated with yersiniosis were recorded in a questionnaire. Antibodies against Y. enterocolitica O:3 were observed more often in the sera of abattoir workers (19%), especially in butchers handling swine throats and intestines (27%), than in the sera of healthy blood donors (10%). During the 6 months preceding this study, 30-40% of the workers reported symptoms of abdominal pains and diarrhoea. However, the symptoms did not correlate with the occurrence of antibodies. One butcher had developed a yersinia-triggered prolonged reactive arthritis. Tonsil samples were collected from 120 pigs to determine the extent of yersinia contamination. Positive isolates were obtained from 54 pigs (45%). Y. enterocolitica O:3 was isolated from 31 pigs and Y. pseudotuberculosis III from 11 pigs. All of these strains shared characteristics typical for virulent strains. We conclude that yersinia infections are an occupational health risk to workers slaughtering swine in the abattoirs.     

Epidemiology of hypothermia: fatalities and hospitalisations in New Zealand

Background: Hypothermia occurs within domestic and non-residential settings. Most epidemiological data originate from the northern hemisphere, with little data being generally available concerning cases from New Zealand and Australia.
Aims: The National Health Statistics Centre (New Zealand) records hospital discharges and deaths. This study isolated hypothermia cases, to quantify its incidence and identify risk groups.
Methods: The morbidity and mortality files for the years 1979-86 (cases = 3,808,717) and 1977-86 (cases = 259,325; respectively) were searched by three investigators.
Results: Hypothermia hospitalisations were identified (6.9 per 100,000 per year). There were 176 deaths from hypothermia, representing 0.07% of the 259,325 deaths from all causes for the same period (0.537 per 100,000 people per year); of these fatalities, 72.2% were classified as domestic, and 27.8% as non-residential; of the domestic fatalities, 86.6% were 65 + years and 35.5% of these were male. Within the non-residential category, 75.5% were aged 13–65, of which 94.6% were male. The hospitalisation incidence was 12.7 times the fatality incidence, with the majority of hospitalisations being of domestic origin (88.4% of total), and occurring mostly within the lower and upper age extremes. Neonatal domestic hypothermia accounted for 72.6% of all domestic hospitalisations, and the elderly constituted 72.0% of the remaining cases. The proportion of New Zealand fatalities caused by hypothermia was 0.067%; lower than reported in the United Kingdom.
Conclusions: The two main non-neonatal groups contributing to cases of hypothermia were males aged 13–65 years, and the elderly. In the aged, the proportion of hypothermia-related deaths was no different from that associated with other disorders, however, the case-fatality ratio was three times greater, highlighting the need for improving prevention and management strategies. (Aust NZ J Med 1994; 24: 705–710.)     

Yersiniosis as a gastrointestinal disease

Anti-yersinia antibodies were assessed in sera from 630 patients admitted to a department of surgery for acute abdominal disease, using an enzyme-linked immunosorbent assay (ELISA). In 21 patients a high concentration of yersinia antibodies confirmed recent yersinia infection. Eight patients had an appendicectomy performed; in all patients with antibodies against Y. enterocolitica 9 or Y. pseudotuberculosis IA a true appendicitis was found at operation. Two patients with Y. enterocolitica 3 antibodies had acute terminal ileitis and mesenterial lymphadenitis. In 4 patients a diagnosis of acute pancreatitis was established; 2 of these had cholecystitis. Two further patients had cholecystitis without pancreatic affection. Two patients had colonic diverticulitis, 1 with perforation. The results demonstrate that yersinia infection may commonly give rise to a variety of acute abdominal inflammations, and stress the importance of serological and bacteriological diagnostic procedures.     

Disseminated Yersinia enterocolitica. Case report and review of the literature

Yersinia enterocolitica is an uncommon cause of infectious diarrhea in the United States. Rarely, it is a cause of extraintestinal disease. Yet an association exists between Y. enterocolitica infection and axial arthropathy. We present a patient with long-standing arthritis, consistent with incomplete Reiter's syndrome, who developed Y. enterocolitica colitis with hepatic and pulmonic infection.     

Risks of transfusion-transmitted infections: 2003

PURPOSE OF REVIEW: While the risks of transfusion-transmitted human immunodeficiency virus, hepatitis C virus, and human T-cell leukemia virus I/II continue to decrease, additional threats to transfusion safety are posed by emerging "new" infectious diseases. RECENT FINDINGS: Following the introduction of nucleic acid testing for human immunodeficiency virus and hepatitis C virus, the American Red Cross estimates the risk of transfusion-transmitted human immunodeficiency virus to be 1:1,215,000 (per unit transfused) and 1:1,935,000 for transfusion-transmitted hepatitis C virus. Hepatitis B virus nucleic acid testing has not been implemented, and the risk of transfusion-transmitted hepatitis B virus in the United States remains relatively high at an estimated 1:205,000. The risk of transfusion-transmitted human T-cell leukemia virus I/II is 1:2,993,000, based on Red Cross estimates. Nucleic acid testing for West Nile virus began in the United States in 2003 under an investigational new drug program. No approved laboratory tests are available to screen the blood for Chagas disease, malaria, severe acute respiratory syndrome, or variant Creutzfeldt-Jakob disease. SUMMARY: Prevention of these potential transfusion-transmitted infections is addressed by deferring potential donors whose personal behaviors or travel histories place them at risk.     

The new epidemiology of hepatitis B in the United States

Although the incidence of hepatitis B virus (HBV) in the United States is decreasing, it remains an important health issue, with nearly 2 million people currently infected and a 7% to 30% lifetime mortality rate. Vaccination has markedly decreased the number of acute HBV cases, especially in children and adolescents; however, there continues to be a substantial incidence of new infections in intravenous drug users and persons with high-risk sexual behavior and of newly recognized disease in immigrants. Perinatal transmission has been significantly reduced with universal infant vaccination, and transfusion/iatrogenic infection has been nearly eradicated by screening blood products and vaccinating at-risk medical professionals. HBV infection rates vary with respect to racial and geographic distribution as well as known risk factors. The Asian/Pacific Islander population continues to have the highest rate (prevalence) of infection in the United States. Further advances in screening and vaccination must be made to further reduce the incidence and prevalence of HBV in the United States.     

Transmission of retroviruses from seronegative donors by transfusion during cardiac surgery. A multicenter study of HIV-1 and HTLV-I/II infections.

OBJECTIVE: To evaluate the effectiveness of serologic testing of blood donors for human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus types I and II (HTLV-I/II) infections and to estimate the risk for transmission of HIV-1 and HTLV-I/II by transfusion of seronegative blood from screened donors. DESIGN: A prospective multicenter cohort study of cardiac surgery patients who received multiple transfusions between 1985 and 1991. SETTING: Cardiac surgery services of three large tertiary care hospitals. PATIENTS: The study included 11,532 patients in three hospitals who had cardiovascular surgery. MEASUREMENTS: Incident HIV-1 and HTLV-I or HTLV-II infection. RESULTS: We detected two new HIV-1 infections among patients transfused with 120,312 units of blood components from seronegative donors. In each case a donor was detected on follow-up who had seroconverted since the donation. The HIV-1 infection rate was 0.0017% with an upper limit of the 95% CI of 0.0053%. Before donor screening for HTLV-I, transfusion of 51,026 units resulted in two HTLV-I infections (0.0039%) and four HTLV-II infections (0.0078%). After HTLV-I screening was instituted, one recipient was infected with HTLV-II among participants exposed to 69,272 units, a rate of 0.0014%. A corresponding HTLV-I/II-infected donor was found for this patient. CONCLUSION: Serologic screening of donors for antibodies to HIV-1 and HTLV-I coupled with exclusion of donors from groups having a relatively high risk for infection has led to a low incidence of transfusion-transmitted HIV-1 and HTLV-I/II infection in the United States. A small risk remains, however, despite these measures. We estimate the residual risk for HIV-1 and HTLV-II infection from transfusion of screened blood during the time of this study to be about 1 in 60,000 units.     

Occupational bladder cancer in New Zealand: a 1-year review of cases notified to the New Zealand Cancer Registry

Abstract
Aim : To identify which cases of adult bladder cancer notified to the New Zealand Cancer Registry in 2001 had a probable occupational cause.
Methods : Occupational Safety and Health (OSH), in conjunction with the Massey University Centre for Public Health Research, interviewed and obtained an occupational history for 210 (162 men, 48 women) cases.
Results : Of the 162 male cases (response rate 65%), 45 (28%) were considered to be 'probable' occupational cancers. Of the 48 female cases (response rate 76%), three cases (6%) were considered to be 'probable' occupational cancers. The largest occupational group for men was truck drivers, which made up 51% of probable cases. Other common groups were engineering and metal workers (18%), crop farmers/orchardists (7%), textile and leather workers (7%), painters/furniture finishers (7%), and plastics manufacturing workers (4%). The three female cases considered to be of occupational origin included two textile workers and one telephonist.
Conclusions : The percentage of cases considered to be of occupational origin is similar to that reported in Europe and the United States, indicating that occupational cancer is a major occupational health problem in New Zealand as it is in other parts of the world. (Intern Med J 2005; 35: 343–347)     

Bacterial antigens in synovial biopsy specimens in yersinia triggered reactive arthritis.

Non-viable structures of Yersinia enterocolitica O:3 were shown at the site of inflammation within mononuclear cells in the synovial membrane of eight out of 10 patients with yersinia triggered reactive arthritis. An avidin-biotin-peroxidase complex method, with a rabbit antiserum specific for Y enterocolitica O:3, was used to visualise yersinia structures. All 13 control samples were negative except for one with non-specific mast cell staining. The findings emphasise the significance of foreign material in the initiation of synovitis in reactive arthritis.     

Human Granulocytic Anaplasmosis in the United States from 2008 to 2012: A Summary of National Surveillance Data

Human granulocytic anaplasmosis is an acute, febrile illness transmitted by the ticks Ixodes scapularis and Ixodes pacificus in the United States. We present a summary of passive surveillance data for cases of anaplasmosis with onset during 2008–2012. The overall reported incidence rate (IR) was 6.3 cases per million person-years. Cases were reported from 38 states and from New York City, with the highest incidence in Minnesota (IR = 97), Wisconsin (IR = 79), and Rhode Island (IR = 51). Thirty-seven percent of cases were classified as confirmed, almost exclusively by polymerase chain reaction. The reported case fatality rate was 0.3% and the reported hospitalization rate was 31%. IRs, hospitalization rates, life-threatening complications, and case fatality rates increased with age group. The IR increased from 2008 to 2012 and the geographic range of reported cases of anaplasmosis appears to have increased since 2000–2007. Our findings are consistent with previous case series and recent reports of the expanding range of the tick vector I. scapularis.     

Transfusion-mediated Yersinia enterocolitica septicemia in an adult patient with beta-thalassemia.

We report a case of transfusion-mediated Yersinia enterocolitica septicemia in a 43-y-old woman with homozygous beta-thalassemia. Two h after transfusion of 3 units of red blood cells the patient suffered high-grade fever and shaking chills. Y. enterocolitica serotype O3 grew in blood cultures. Prolonged treatment with i.v. ceftriaxone plus ciprofloxacin led to a favorable outcome. Transfusion-associated Y. enterocolitica septicemia has not previously been reported in an adult beta-thalassemic patient from the Mediterranean area. Our report is particularly important, because of the high incidence of chronically transfused thalassemic patients in Mediterranean countries.     

Immunoblot analysis of IgM, IgG, and IgA responses to plasmid encoded released proteins of Yersinia enterocolitica in patients with or without yersinia triggered reactive arthritis.

The IgM, IgG, and IgA antibody responses of patients with Yersinia enterocolitica O:3 infection were studied by immunoblotting with plasmid encoded released proteins of Y enterocolitica as the antigens. The results indicate that antibodies of all three classes are most consistently directed against the proteins of molecular weights 25,000 and 36,000. Less than two months after the onset of infection 18 of the 19 patients with yersinia triggered reactive arthritis had IgA class antibodies against the released protein of mol. wt 36,000, whereas only eight of the 17 patients with non-arthritic yersiniosis had these antibodies. The same difference between the arthritic and non-arthritic patients was observed also 8-12 months after the onset of infection.     

A REPORT OF THREE CASES OF YERSINIA REACTIVE ARTHRITIS

Three cases of reactive arthritis associated with Yersinia enterocolitica bowel infection are reported. In one case Y. enterocolitica was cultured from stools while all three exhibited a significant increase in serum antibody titres to Y. enterocolitica. These are believed to be the first reports of Yersinia reactive arthritis in Australia. Synovial membrane biopsy in one case revealed a mixed inflammatory cell infiltrate the appearance of which was quite dissimilar to that of rheumatoid arthritis (RA). Mononuclear cells of the peripheral blood, but not the synovial fluid from another patient had reduced functional activity compared to RA patients as determined by response to phytohemagglutinin stimulation and allogeneic responses. Large numbers of HLA-DR and acid phosphatase positive macrophages were also found in the synovial fluid of this patient. The reason for joint involvement in Y. enterocolitica reactive arthritis is unknown and further work is necessary. (Aust NZ J Med 1985; 15: 331–335.)     

Transfusion-transmitted bacterial infection: risks, sources and interventions

Records of the transmission of bacterial infections by transfusion date back to the beginning of organized blood banking. Despite tremendous strides in preventing viral infection through careful donor screening and viral testing, there has been little improvement in reducing the risk of bacterial sepsis since the introduction of closed collection systems. Based on the French Haemovigilance study, the British Serious Hazards of Transmission (SHOT) study and fatality reports to the United States Food and Drug Administration, the risk of clinically apparent sepsis exceeds the risk of HIV, HBV, and HCV transmission. Sources of contamination include the skin, blood, disposables, and the environment. Potential interventions to reduce transfusion-associated bacterial sepsis include improvements to donor arm preparation, diversion of the first aliquot of whole blood, introduction of bacterial testing and/or implementation of pathogen reduction methods.