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Borrelia Burgdorferi Vector and Reservoir Involved: • Ixodes (Hard) Ticks, Referred to As Black-Legged Or Deer Disease Agent: Ticks, Including I

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Borrelia Burgdorferi Vector and Reservoir Involved: • Ixodes (Hard) Ticks, Referred to As Black-Legged Or Deer Disease Agent: Ticks, Including I APPENDIX 2 Borrelia burgdorferi Vector and Reservoir Involved: • Ixodes (hard) ticks, referred to as black-legged or deer Disease Agent: ticks, including I. scapularis and I. pacificus—Same • Borrelia burgdorferi tick also can be infected with B. microti and A. phago- cytophilum. Disease Agent Characteristics: • White-footed mice (Peromyscus leucopus) and white- • Not classified as either Gram-positive or Gram- tailed deer (Odocoileus virginianus) serve as reservoir negative, facultatively intracellular bacterium hosts; unlike mice, deer do not become infected but • Order: Spirochaetales; Family: Spirochaetaceae serve to transport and maintain the tick population. • Size: 20-30 ¥ 0.2-0.3 mm • Birds and other animals may contribute to the spread • Nucleic acid: Approximately 1440 kb of DNA includ- of infected ticks. ing the genome and several plasmids Blood Phase: Disease Name: • Spirochete grows in skin and often causes character- istic erythema migrans (EM; bull’s eye rash) and then • Lyme Disease enters the blood days to weeks after the initial infec- • Lyme borreliosis tion, enabling the spread of the spirochete to other Priority Level: areas of the body. • Positive blood cultures are found but are infrequent, • Scientific/Epidemiologic evidence regarding blood and the detection period is short lived. safety: Theoretical • Public perception and/or regulatory concern regard- Survival/Persistence in Blood Products: ing blood safety: Very low • Laboratory studies indicate that B. burgdorferi sur- • Public concern regarding disease agent: Moderate vives in fresh frozen plasma, RBCs, and platelets for Background: the duration of its storage period. • First identified in 1977 following an investigation of a Transmission by Blood Transfusion: cluster of arthritis cases among children in Lyme, • Theoretical; no transfusion case has been docu- Connecticut mented. In lookback studies of recipients of compo- • Present throughout the northern hemisphere and is nents from DNA-positive donors, no evidence of the most commonly reported vector-borne disease in infection was found. the US • Frequency of reported cases in the US annually has Cases/Frequency in Population: increased 101% from 9908 in 1992 to 19,931 in 2006; • Notifiable disease in the US observed increase is highest in children. • In excess of 20,000 cases reported in the US annually • Geographic distribution of cases is highly focused since 2006 with the majority of reported cases occurring in 10 • Case reporting is on the increase likely because of states within the northeastern and north central US. increases in recognition, in tick density, and/or • Emergence linked with changes in the environment encroachment of humans into rural/suburban areas, favoring deer and rodent reservoirs and changing and to geographic expansion of reservoir mammals residential patterns putting humans in more intimate and ticks. contact with the tick vector. Incubation Period: Common Human Exposure Routes: • For erythema migrans, 3-32 days • Bite of infected tick; for transmission to occur, the tick must be attached to the human host for a minimum Likelihood of Clinical Disease: of 36 hours. • Early infection appears to be asymptomatic in about Likelihood of Secondary Transmission: 11% of infected individuals in the US. • Approximately 60% of patients present with an EM • None rash as the first manifestation. At-Risk Populations: Primary Disease Symptoms: • Persons with exposure to the tick vector (gardeners, • Characteristic EM rash in 70-80% of cases within 30 campers, forestry workers, hikers, etc.) days 194S TRANSFUSION Volume 49, August 2009 Supplement APPENDIX 2 • A wide variety including: malaise, fatigue, headache, tions. Lyme vaccination and cross-reactivity with myalgias, large joint arthralgias, neurological, and other Borrelia species also cause problems. cardiac symptoms • NAT methods exist. • These may not immediately suggest Lyme disease in • The organism requires special media for culture and the absence of EM rash or known tick exposure. would not be detected by platelet bacterial culture. Severity of Clinical Disease: Currently Recommended Donor Deferral Period: • Generally self-limiting, even without treatment • No FDA Guidance or AABB Standard exists. • May cause permanent impairment because of joint, • Prudent practice would be to defer donor until signs cardiac, or neurological problems and symptoms are gone and a course of treatment is • In rare cases, life-threatening complications may completed. occur. Impact on Blood Availability: Mortality: • Agent-specific screening question(s): Not applicable • Rare • Laboratory test(s) available: Not applicable Chronic Carriage: Impact on Blood Safety: • The existence of chronic, antibiotic unresponsive • Agent-specific screening question(s): Not applicable infection is controversial. • Laboratory test(s) available: Not applicable • Some experts contend that prolonged clinical symp- Leukoreduction Efficacy: toms are a result of co-infection with Babesia or Anaplasma. • Unknown but unlikely to be efficacious as bacteria • Chronic asymptomatic spirochetemia has not been can be isolated from cell-free plasma. documented. Pathogen Reduction Efficacy for Plasma Derivatives: Treatment Available/Efficacious: • Specific data indicate that the multiple steps in the • Antibiotics (e.g., doxycycline, tetracycline, amoxicil- fractionation process are robust and capable of inac- lin, cefuroxime, ceftriaxone, and penicillin) are used, tivating and/or removing bacteria at concentrations based on disease stages and manifestations. that may be present in plasma. • Anti-inflammatory medications, such as ibuprofen, Other Prevention Measures: are sometimes used to relieve joint stiffness. • Tick avoidance measures (e.g., long pants, long Agent-Specific Screening Question(s): sleeves, repellants) • No specific question is in use. • Tick control measures in the environment • Not indicated because transfusion transmission has • Vaccine is no longer available. not been demonstrated. Suggested Reading: • No sensitive or specific question is feasible. In endemic areas, a question on exposure to tick bites 1. Badon SJ, Fister RD, Cable RG. Survival of Borrelia has been shown to be ineffective in distinguishing burgdorferi in blood products. Transfusion 1989;29: Babesia-infected from Babesia-uninfected donors. 581-3. This question probably also lacks sensitivity and 2. Centers for Disease Control and Prevention. Surveil- specificity for Borrelia burgdorferi. lance for Lyme Disease United States 1992-2006; Morb Mortal Wkly Rep MMWR Surveillance Summa- Laboratory Test(s) Available: ries 2008;57:NoSS-10. • No FDA-licensed blood donor screening test exists. 3. Coulter P, Lema C, Flayhart D, Linhardt AS, Linhardt • Various methods have relatively poor correlation AS, Aucott JN, Auwaerter PG, Dumler JS. Two-year among each other or for clinical diagnosis. EIA tests evaluation of Borrelia burgdorferi culture and supple- have had better reproducibility, sensitivity, and speci- mental tests for definitive diagnosis of Lyme disease. J ficity. IFA (detecting both IgM/IgG) using paired Clin Microbiol 2005;43:5080-4. samples is the most commonly used single method 4. Gabitzsch ES, Piesman J, Dolan MC, Sykes CM, for diagnosis. A two-test approach (sensitive EIA or Zeidner NS. Transfer of Borrelia burgdorferi s.s. infec- IFA followed by western blot) has been recently rec- tion via blood transfusion in a murine model. J Para- ommended by the CDC. sitology 2006;92:869-70. • Poor specificity has been observed with all serologic 5. Gerber MA, Shapiro ED, Krause PJ, Cable RG, Badon methods when used in healthy nonendemic popula- SJ, Ryan RW. The risk of acquiring Lyme disease or Volume 49, August 2009 Supplement TRANSFUSION 195S APPENDIX 2 babesiosis from a blood transfusion. J Infect Dis 1994; 8. Vaz A, Glickstein L, Field JA, McHugh G, Sikand VK, 170:231-4. Damle N, Steere AC. Cellular and humoral immune 6. Steere AC, Coburn J, and Glickstein L. The emergence responses to Borrelia burgdorferi antigens in patients of Lyme disease. J Clin Invest 2004;113:1093-101. with culture-positive early Lyme disease. Infect 7. Steere AC, Sikand VK, Schoen RT, Nowakowski J. Immun 2001;69:7437-44. Asymptomatic infection with Borrelia burgdorferi. Clin Infect Dis 2003;37:528-32. 196S TRANSFUSION Volume 49, August 2009 Supplement.
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