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Unusual Presentation of Phaechromocytoma in a Child- A September 2006 Volume 40, Number 3 GHANA MEDICAL JOURNAL SEROPREVALENCE OF CYTOMEGALOVIRUS AMONG SOME VOLUNTARY BLOOD DONORS AT THE 37 MILITARY HOSPITAL, ACCRA, GHANA *A.A. ADJEI, H.B. ARMAH AND E.G. NARTER-OLAGA Department of Pathology, University of Ghana Medical School, College of Health Sciences, Korle-Bu, Accra, Ghana. SUMMARY world. The presence of viruses in blood cells or Background: Cytomegalovirus (CMV) is one of plasma of asymptomatic donors is the major risk the most significant pathogens infecting immuno- factor for transmitting infectious agents through suppressed individuals. CMV is transmissible blood transfusion. Other transfusion transmitted through transfusion of blood components. agents include bacteria, mycoplasma, and even Aim: The goal of this study was to determine the protozoa. The main viruses associated with trans- seroprevalence of antibodies to CMV among blood fusion related infections are hepatitis viruses, ret- 1,2 donors seen at the 37 Military Hospital Blood roviruses, and cytomegalovirus (CMV) . The risk Transfusion Unit, (MHBTU) Accra, Ghana. of transmitting hepatitis viruses, human retrovi- Methods: The seroprevalence of antibodies spe- ruses, such as human immunodeficiency virus cific for CMV was tested using CMV IgG/IgM (HIV) and human T-lymphotropic viruses types I particle agglutination test kit and ELISA. and II has been reduced drastically by screening Results: Of the 264 blood donors, 18 were nega- for the corresponding antibodies before transfu- tive and 246 were positive for CMV IgG antibod- sion. ies, giving an overall CMV prevalence rate of 93.2%. None of the 264 blood donors was posi- However, CMV, a member of the human herpes tive for CMV IgM antibodies. About 96% of the family of viruses, transmissible through blood donors aged between 30 to 39 years were seroposi- component transfusions is an important cause of tive for CMV, as against 91.9% in those aged 20- concern world-wide. This is because the majority 29 years, 88.6% in 40 to 49 years, 75.0% (3 out of of adults have serological evidence of previous 4) in 50 to 59 years, and 100% (1 out 1) in 60-69 infections by these viruses. CMV is a ubiquitous years. There was no statistically significant differ- agent, and seropositivity rates in the adult popula- ence (P>0.05) in the CMV IgG status in different tion over 40 years of age worldwide are 60 to age groups. The blood donors comprised largely 100%, possibly due to transmission through of male donors (236 out of 264), making sex com- breastfeeding, sexual contact and spread from 3,4 parisons statistically undesirable. However, all the children . Like most other herpesviruses, they female (n=28) donors were positive for CMV IgG. remain latent in the host after primary infection Conclusion: Since about 93% of blood donors at and persist for lifelong in the organism. Neverthe- the MHBTU are seropositive for CMV, it would less, these viruses can be reactivated in immuno- be very useful to screen blood donors in Ghana for suppressed individuals leading to critical outcomes CMV to identify the very few CMV-seronegative such as interstitial pneumonitis, hepatitis, retinitis, 5-7 blood donors, and maintain an inventory of them and encephalitis . Active infection results in se- for use as donors. rious morbidity and mortality, and many consider CMV to be one of the most serious pathogens af- Keywords: Cytomegalovirus, blood donors, sero- fecting immunosuppressed individuals and an im- 8-10 prevalence. portant contribution to intrauterine infection . In one study, the relative risk of CMV disease trans- mission via blood components from seropositive INTRODUCTION 11 Transfusion transmitted disease (TTD) is a major donors was 0.4% to 12% . Transfusion- challenge to the transfusion services all over the transmitted CMV (TT-CMV) is a significant cause * Author for correspondence 99 September 2006 A.A. Adjei et al Cytomegalovirus among blood donors of morbidity and mortality in immunosuppressed perature; not belonging to any high-risk group patients. (homosexually/heterosexually promiscuous, intra- venous drug addicts; patients of sexually transmit- The widespread prevalence of CMV seropositivity ted diseases; and no history of any severe current makes it difficult for some blood banks to maintain or chronic illnesses). Donors found to be healthy sufficient CMV seronegative blood components are then permitted to donate blood. Donated blood for patients at risk for CMV disease. Therefore, is routinely screened for HIV 1 & 2, HBsAg, anti- the most effective way to minimize the risk of HCV and syphilis antibodies. CMV transmission in high-risk recipients would be to administer CMV seronegative blood products Sera were screened for the presence of antibodies or leucoreduced blood products12,13. Otherwise, a to CMV in parallel with a commercially available way out would be to determine the frequency of CMV IgG/IgM particle agglutination test kit primary CMV infection among seronegative blood (PAT; Serodia Fujirebio Inc. Japan) and ELISA donors14. A previous study in Ghana identified (anti-HCMV recombinant IgG/IgM; Dade CMV infection (cytomegaloviral eosophagitis and Behring, Marburg, Germany) in accordance with enteritis) as one of the major opportunistic infec- the manufacturer’s instructions. Positive and tions in Ghanaian HIV-AIDS patients at autopsy15, negative standard sera, accompanying the kit were without identifying if the infections in these pa- included in each assay. The study was approved tients were transfusion-related or not. by the Ethical and Protocol Review Committee of the University of Ghana Medical School, Accra, The 37 Military Hospital is a 600-bed national Ghana, referral hospital for military personnel and other soldiers from the West Africa sub-region on Statistical analysis of the data was performed by peace-keeping missions. According to the Military calculating the Odds Ratio (OR) and the corre- Hospital Blood Transfusion Unit (MHBTU) esti- sponding 95% confidence intervals in the compari- mation, the number of blood units transfused at the son of the age group having the lowest seropositiv- Hospital in 2002 was 9,000 units. In view of the ity rate with other age groups, and then performing large number of transfusions carried out at the the Chi-square test. P values <0.05 were consid- Hospital and their great potential for transmitting ered statistically significant. blood associated pathogens to the recipients, it is extremely necessary that the presence of antibod- RESULTS ies to CMV among blood donors be determined. Of the 264 blood donors, 236 (89.4%) were males Currently, such a procedure has not been estab- and 28 (10.6%) were females. Their mean age was lished at the MHBTU. Donor blood is screened 32.1 years (range 19 to 64 years). Sera reactive by only for HIV, hepatitis B virus (HBV), hepatitis C both the PAT and ELISA test were considered as virus (HCV) and syphilis. The present study was positive; and those reactive by either PAT or undertaken to determine the prevalence of antibod- ELISA test, or neither PAT or ELISA test were ies to CMV infection among blood donors at the considered negative. The combined results showed MHBTU. Such information may be invaluable to that 18 were negative (16 were non-reactive by health planners at the hospital and policy makers both PAT and ELISA test, and 1 each was reactive in Ghana. to only PAT or only ELISA test) and 246 were positive for CMV IgG antibodies, giving an over- SUBJECTS AND METHODS all CMV prevalence rate of 93.2%. None of the This study was carried out between the months of 264 blood donors were reactive for CMV IgM January and April 2004 among blood donors at the antibodies by either the PAT or ELISA tests. MHBTU. This unit serves the military personnel, their dependants, surrounding urban population, Table 1 shows the combined results of CMV IgG and also referred cases from other military person- seropositivity and age of blood donors. About nel from other countries on peace-keeping mis- ninety-six (96%) percent of the donors (132 out of sions in the West African sub-region. In Ghana, 138) aged between 30 to 39 years were serpositive blood donors are volunteers and are also sought for CMV, as against 91.9% (79 out of 86) in 20 to from family members of patients and friends need- 29 years, 88.6% (31 out of 35) in 40 to 49 years, ing blood transfusion. They are selected based on and 75.0% (3 out of 4) in 50 to 59 years, and 100% the following criteria: age between 18 and 60 (1 out of 1) in 60 to 69 years. There was no statis- years; weight >45 kg; haemoglobin >12.5 g/dl; tically significant difference (P>0.05) in the CMV normal blood pressure [BP], pulse, and body tem- IgG status in different age groups. The blood do- 100 September 2006 Volume 40, Number 3 GHANA MEDICAL JOURNAL nors comprised largely of male donors (236 out of templated in high-risk individuals22. These guide- 264), making sex comparisons statistically unde- lines have helped in drastically minimizing trans- sirable. However, all the female (n=28) donors fusion-transmitted (TT) CMV infection in immu- were positive for CMV IgG. nosuppressed recipients in the US. Since about 93% of blood donors at the MHBTU are seroposi- Table 1 Seroprevalence rate of CMV IgG among tive for CMV, it would therefore be very useful to blood donors of different age groups in Ghana screen blood donors in Ghana for CMV to identify the very few CMV-seronegative blood donors, and Age Fre- Number of OR P maintain an inventory of them for use as donors quency
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