APPENDIX 2
Chlamydia pneumoniae Transmission by Blood Transfusion: • Theoretical Disease Agent: Cases/Frequency in Population: • Chlamydia pneumoniae • Roughly 50% of adults show signs of previous expo- Disease Agent Characteristics: sure worldwide. 10% of community acquired pneu- • Gram-negative, coccoid, nonmotile, nonspore-form- monia, and 5% of sinusitis cases are thought to be ing, obligate intracellular bacterium caused by C. pneumoniae. • Order: Chamydiales; Family: Chlamydiaceae Incubation Period: • Size: 0.2 to 0.4 mm • Nucleic acid: The genome of Chlamydia pneumoniae • Greater than 3 weeks based on serology is 1234 kb of DNA. Likelihood of Clinical Disease: Disease Name: • Unknown • Can be a cause of pneumonia and bronchitis Primary Disease Symptoms: Priority Level: • Cough, mild fever, pharyngitis, hoarseness, • Scientific/Epidemiologic evidence regarding blood pneumonitis safety: Theoretical Severity of Clinical Disease: • Public perception and/or regulatory concern regard- ing blood safety: Absent • Usually low, with elderly individuals at increased risk • Public concern regarding disease agent: Very low for severe disease • Has been associated with arthritis and atherosclerotic Background: heart disease in epidemiologic studies • Stable in the population • Well-designed secondary prevention trials using • Considered a common cause of pneumonia antibiotics active against C. pneumoniae have been worldwide uniformly negative raising questions about the sig- nificance of the association with coronary artery Common Human Exposure Routes: disease. • Person-to-person through respiratory droplets, no Mortality: other reservoirs known • Low except as complicated pneumonia Likelihood of Secondary Transmission: Chronic Carriage: • Inefficient by direct contact •Yes At-Risk Populations: Treatment Available/Efficacious: • Elementary school-age children (between 5 and 14 years) old at greater risk • Treatment with antibiotics (e.g., erythromycin, • General population—High seroprevalence (50% of azithromycin, clarithromycin, fluoroquinolones and young adults) their derivatives [such as levofloxacin], and tetracy- clines [such as doxycycline]) Vector and Reservoir Involved: • In severe cases, treatment with intravenous antibiot- • Human reservoir ics and oxygen supplementation may be required.
Blood Phase: Agent-Specific Screening Question(s):
• Specific DNA and RNA transcripts demonstrated by • No specific question is in use. PCR in PBMC are found in a number of blood donors • Not indicated because transfusion transmission has and symptomatic and asymptomatic patients and not been demonstrated can persist for months or years. • No sensitive or specific question is feasible. • Culture has not been successful from blood. Laboratory Test(s) Available: Survival/Persistence in Blood Products: • No FDA-licensed blood donor screening test exists. • Not well studied. Only fresh products used in filtra- • Serology: Commercially available microimmunofluo- tion studies rescence (MIF) and EIAs are most commonly used.
202S TRANSFUSION Volume 49, August 2009 Supplement APPENDIX 2
Although quite technically challenging, MIF appears Suggested Reading: more frequently in the literature as a “gold standard” 1. Colmegna I, Cuchacovich R, Espinoza LR. HLA-B27- for serological confirmation. associated reactive arthritis: pathogenic and clinical • Nucleic acid methods: PCR, nested PCR, and touch- considerations. Clin Microbiol Rev 2004;17:348-69. down enzyme time-release PCR also noted as useful. 2. Hogan RJ, Mathews SA, Mukhopadhyay S, Summers- Prevalence of DNA detection highly dependent on gill JT, Timms P. Chlamydial persistence: beyond the which primers are used. biphasic paradigm. Infect Immun 2004;72:1843-55. Currently Recommended Donor Deferral Period: 3. Ikejima H, Friedman H, Leparc GF, Yamamoto Y. Depletion of resident Chlamydia pneumoniae • No FDA Guidance or AABB Standard exists. through leukoreduction by filtration of blood for • Prudent practice would be to defer donor until signs transfusion. J Clin Microbiol 2005;43:4580-4. and symptoms are gone and a course of treatment is 4. Kuo CC, Jackson LA, Campbell LA, Grayston JT. completed. Chlamydia pneumoniae (TWAR). Clin Microbiol Rev 1995;8:451-61. Impact on Blood Availability: 5. Paldanius M, Bloigu A, Alho M, Leinonen M, Saikku P. • Agent-specific screening question(s): Not applicable Prevalence and persistence of Chlamydia pneumo- • Laboratory test(s) available: Not applicable niae in healthy laboratory personnel in Finland. Clin Diagn Lab Immunol 2005;12:654-9. Impact on Blood Safety: 6. Smieja M, Mahony J, Petrich A, Boman J, Chernesky M. Association of circulating Chlamydia pneumoniae • Agent-specific screening question(s): Not applicable DNA with cardiovascular disease: a systematic review. • Laboratory test(s) available: Not applicable BMC Infect Dis 2002; 2:21. 7. Verkooyen RP, Willemse D, Hiep-van Casteren SC, Leukoreduction Efficacy: Mousavi Joulandan SA, Snijder RJ, van den Bosch JM, • Filtration significantly reduces the number of bacte- van Helden HP, Peeters MF,Verbrugh HA. Evaluation ria present in blood products and the number of posi- of PCR, culture, and serology for diagnosis of Chlamy- tive test results from those products. dia pneumoniae respiratory infections. J Clin Micro- biol 1998;36:2301-7. Pathogen Reduction Efficacy for Plasma Derivatives: 8. Wald NJ, Law MR, Morris JK, Zhou X, Wong Y, Ward ME. Chlamydia pneumoniae infection and mortality • Specific data indicate that the multiple steps in the from ischaemic heart disease: large prospective study. fractionation process are robust and capable of inac- BMJ 2000;321:204-7. tivating and/or removing bacteria at concentrations 9. Yamaguchi H, Yamada M, Uruma T, Kanamori M, that may be present in plasma. Goto H, Yamamoto Y, Kamiya S. Prevalence of viable Other Prevention Measures: Chlamydia pneumoniae in peripheral blood mono- nuclear cells of healthy blood donors. Transfusion • Unknown 2004;44:1072-8.
Volume 49, August 2009 Supplement TRANSFUSION 203S