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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

  1. Stenhouse MAE, Milner LV. Yersinia enterocolitica: a hazard in blood transfusion. Transfusion 1982;22:396-8.

  2. 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.

  3. Bjune G, Ruud TE, Eng J. Bacterial shock due to transfusion with Yersinia enterocolitica infected blood. Scand J Infect Dis 1984;16:411-2.

  4. Wright DC, Selss IF, Vinton KJ, Pierce RN. Fatal Yersinia enterocolitica sepsis after blood transfusion. Arch Pathol Lab Med 1985;109:1040-2.

  5. 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.

  6. Galloway SJ, Jones PD. Transfusion acquired Yersinia enterocolitica. Aust NZ J Med 1986;16:248.



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