A pilot serosurvey of Babesia microti in Chinese blood donors.

BACKGROUND AND OBJECTIVES: Babesia spp. are tick-borne, intraerythrocytic protozoan parasites, several of which are transfusion-transmissible. Transfusion-transmitted babesiosis poses serious risk to a diverse patient population, including neonates, patients aged >50 years, the asplenic and the immunocompromised that are over-represented among transfusion recipients. Despite reports of B. microti and B. venatorum in People's Republic of China (PRC), no surveillance of blood donors for Babesia has previously been undertaken. We sought to determine the rates of B. microti seroreactivity in a sample of blood donors in the PRC. MATERIALS AND METHODS: A pilot serosurvey was conducted of community blood donors (n = 1000) who donated July-August 2016 at Mudanjiang Blood Center (Heilongjiang Province) using indirect fluorescent antibody testing for antibodies against B. microti. The slides were prepared using B. microti-infected hamster blood. Samples that were initially positive to a titre of 64 were subjected to repeat IFA testing. Final seroreactivity was based on repeat reactivity to ≥64. RESULTS: A total of 1000 individual donor samples were evaluated, comprising 888 whole blood and 112 platelet donations. Thirteen of 1000 (1·3%) donors were seroreactive for B. microti [8 (0·8%) and five (0·05%) at titres of 64 and 128, respectively]. CONCLUSION: Our preliminary findings support the need for expanded Babesia surveillance in Chinese blood donors, replete with molecular evaluation, to evaluate the risk to the blood supply.

Evidence of Trypanosoma cruzi infection (Chagas' disease) among patients undergoing cardiac surgery.

BACKGROUND: Trypanosoma cruzi, the agent of Chagas' heart disease, is transmitted by triatomine insects and by blood transfusion. The emigration of several million people from T cruzi-endemic countries to the United States has raised concerns regarding a possible increase in cases of Chagas' heart disease here, as well as an increased risk of transfusion-transmitted T cruzi. To investigate these 2 possible outcomes, we tested a repository of blood specimens from multiply transfused cardiac surgery patients for antibodies to T cruzi. METHODS AND RESULTS: Postoperative blood specimens from 11 430 cardiac surgery patients were tested by enzyme immunoassay, and if repeat-reactive, were confirmed by radioimmunoprecipitation. Six postoperative specimens (0.05%) were confirmed positive. Corresponding preoperative specimens, available for 4 of these patients, were also positive. The other 2 patients had undergone heart transplantations. Tissue samples from their excised hearts were tested for T cruzi by polymerase chain reaction and were positive. Despite the fact that several of these 6 patients had histories and clinical findings suggestive of Chagas' disease, none of them were diagnosed with or tested for it. Patient demographics showed that 5 of 6 positive patients were Hispanic, and overall, 2. 7% of Hispanic patients in the repository were positive. CONCLUSIONS: No evidence for transfusion-transmitted T cruzi was found. All 6 seropositive patients apparently were infected with T cruzi before surgery; however, a diagnosis of Chagas' disease was not known or even considered in any of these patients. Indeed, Chagas' disease may be an underdiagnosed cause of cardiac disease in the United States, particularly among patients born in countries in which T cruzi is endemic.

Emerging infectious agents.

As new agents of infectious disease continue to emerge and old antagonists reemerge, it is clear that the war on infectious disease is far from over. Indeed, the appearance of SARS during the past year is the latest example of the continuing challenges posed by agents of infectious disease. Emerging agents are threats not only to the general population, but also to recipients of blood transfusions. Today a variety of emerging agents are of concern to transfusion safety including Trypanosoma cruzi, West Nile virus, and Babesia microti to name but a few. These and other emerging agents have arisen or have been introduced partly through changes in donor demographics, international travel, microbial adaptations, land use, and human behaviour. Unfortunately, for many of these agents there is an absence of viable tests or other sound interventions to prevent their transmission at this time.

Negligible prevalence of antibodies against Trypanosoma cruzi among blood donors in the southeastern United States.

Trypanosoma cruzi, a hemoflagellate, causes Chagas' disease and is endemic throughout Latin America. Increasing Latin American immigration to the United States has enhanced concern about transmission of Chagas' disease by infected donor blood. The insect vector and parasites also have been found in the southeastern United States. Autochthonous infection of several species of wild and domesticated mammals suggests that the general human population also may be at risk. To assess the prevalence of antibodies to T cruzi in humans, randomly selected donor blood was screened. Initial screening was performed by indirect hemagglutination (1:4 initial serum dilution) and at least one of three different enzyme immunoassays. All samples testing positive by at least one screening method were tested by radioimmunoprecipitation and indirect immunofluorescence supplemental methods, which were used for confirmation and calculation of specificity. Of the 6,013 serum samples evaluated, 85 tested positive by one screening method. Only 10 of the samples tested positive by more than one method. The percentages of positive screening tests are 0.05% by indirect hemagglutination and 0.06%, 0.91%, 3.97% by Abbott Laboratories (Abbott Park, Ill), Gull (Gull Laboratories, Salt Lake City, Utah), and Polychaco (Polychaco S.A.I.C., Buenos Aires, Argentina) enzyme immunoassays, respectively. All samples were negative by radioimmunoprecipitation and indirect immunofluorescence. These results suggest that although parasite and vector are found in the southeastern United States and both infect mammals, the risk of natural infection to humans in this region seems to be negligible. There was variation in positivity among different screening methods. The highest percentage of positive results was with the enzyme immunoassay, in which the binding of serum antibodies to antigens is amplified by enzymatic reactions.

A comparison of three geographical isolates of Trichinella spiralis from the mid-Atlantic United States.

Three isolates of Trichinella spiralis (black bear: 41o50'N, 79o00'W, 1982; grey fox: 41o00'N, 76o00'W, 1982; domestic pig: 39o80'N, 75o30'W, 1983) from the mid-Atlantic United States were characterized in Crl: COBS CFW (SW) mice during 10 successive 40-day generations. Over 10 generations, the isolates differed as follows: worm position of the ursine isolate was significantly more posteriad compared to the porcine isolate; sex ratio of the vulpine isolate was significantly lower compared to the ursine and porcine isolates; females of the porcine isolate produced significantly more newborn larvae in vitro than the sylvatic isolates; both the larvae per gram (LPG) and reproductive capacity index (RCI) were significantly higher for the porcine isolate; and male worms of the vulpine isolate were significantly smaller than those of the porcine or ursine isolates. No differences were observed among isolates for percentage of inoculum recovered, length of female worms, or uterine length. The fecundity of the isolates in hamsters, gerbils, multimammate rats, Sprague-Dawley rats, and Peromyscus sp. was examined also. Based upon RCI and LPG, the porcine isolate was the most fecund in all hosts except gerbils. This higher fecundity was often manifest as increased morbidity and mortality in hosts infected with this isolate. The relationship between the virulent nature of the porcine isolate and the enhanced transmission of T. spiralis are discussed.

Variation in the sizes of eggs and oncospheres and the numbers and distributions of testes in the tapeworm, Hymenolepis diminuta.

Four "strains" of Hymenolepis diminuta were examined for morphological variation. These included the ARME "strain" (currently maintained at the University of Keele, U.K.), the OSU "strain" (currently maintained at The Ohio State University) and the TOR (or UT) "strain" (currently maintained at the University of Toronto), all of which were derived from the parental RICE "strain," and the ANU "strain" (currently maintained at the Australian National University). Additionally, 2 separate "clonal" populations (populations derived from single cysticercoids) from both the OSU and ANU "strains" were examined. All "strains" and "clones" were maintained under identical conditions using Tenebrio molitor and male Sprague-Dawley rats as the intermediate and definitive hosts, respectively. The lengths and widths of eggs and larvae (oncospheres) passed in the hosts' feces, and the numbers and distributions of testes in proglottids were quantified and the data analyzed. Although analyses of the lengths and widths of eggs and larvae demonstrated significant differences among some "strains" and "clones," a discriminate analysis of the data indicated these parameters to be of questionable taxonomic significance. The eggs of all "strains" and "clones" consisted of 2 distinct populations differing in density and size but not infectivity; the relative proportions of eggs in the 2 populations were not determined. Considering all possible numbers and distributions of testes, 17 variations were seen in the strobilae of tapeworms. Analyses of the data demonstrated that the "strains" and "clones" could be differentiated clearly using only the frequencies of the 1p2a (1 poral and 2 aporal testes) or 1p3a distribution, or the frequencies of proglottids containing 3 or 4 testes; all other variations failed to clearly differentiate or group the various "strains" and "clones."(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution, prevalence and intensity of Trichinella spiralis infection in furbearing mammals of Pennsylvania.

Tongues from 1,170 raccoons, 384 opossums, 201 muskrats, 168 foxes (red and grey), 51 skunks, and 17 mink from Pennsylvania were examined for Trichinella spiralis larvae by peptic digestion. The overall prevalence of T. spiralis infection was 3.2%, varying in the carnivores from 2.6% in raccoons to 15.1% in red foxes; no muskrats were infected. Prevalence varied regionally, being higher west of the Susquehanna River, where, in the Ridge and Valley Province, it reached 9%. The larval densities varied greatly as reflected by the overall geometric mean number of larvae per gram of muscle (LPG) of 18.5 and the comparable arithmetic mean LPG of 113.3. No geographic, sex, or species-related differences in the intensity of infection were demonstrated.

Trichinella spiralis in an agricultural ecosystem. II. Evidence for natural transmission of Trichinella spiralis spiralis from domestic swine to wildlife.

Epidemiological investigations of an outbreak of trichinellosis were carried out in a domestic swine herd and it was established that the parasite also occurred in rats, and in skunks, opossums, and raccoons. Because considerable uncertainty exists regarding the role of sylvatic trichinellosis as a reservoir for the synanthropic cycle, studies were conducted to determine the genetic nature of the various isolates from this ecosystem. Pig infectivity trials, isoenzyme analyses, and repetitive DNA sequence analyses were performed. The results showed that all isolates from the farm environs were genetically similar and that they are related to Trichinella spiralis isolated from domestic pigs. The implication of these findings, in contrast to studies on isolates from wildlife elsewhere, is that this parasite is transmitted from domestic swine to sylvatic hosts and that any control or eradication efforts must take into account the potential for reinfection of hogs from wild animals.

Trichinella spiralis in an agricultural ecosystem: transmission under natural and experimentally modified on-farm conditions.

A hog found infected with Trichinella spiralis at slaughter was traced to its farm of origin, where an epidemiological investigation found the infection prevalent in swine and rats. Garbage-feeding was not responsible for maintaining the high prevalence of infection on this farm, although it may have been responsible historically for the introduction of the infection. Poor husbandry, malnutrition, and intercurrent disease resulted in frequent death and the availability of porcine carcasses for cannibalism. Tissue samples from partly devoured carcasses contained T. spiralis larvae, implicating cannibalism as a major vehicle for the spread of T. spiralis in the herd. Rats also fed on these carcasses, and their rate of infection increased markedly during the first 5 mo of observation. Experimental investigation indicated that rats could also be important in maintaining a high prevalence of infection in swine. For the purpose of our investigation, the farm was depopulated of swine and restocked with parasite-free, sentinel pigs confined in 3 groups exposed to increasing degrees of contact with rats. Pigs exposed to large numbers of rats acquired infections rapidly, whereas pigs with strongly limited rat exposure failed to acquire infection during a 12-mo period. These results indicate that, when rats are available to swine and the prevalence of T. spiralis infection in the former is high, predation (or scavenging) on rats may be as effective as cannibalism in maintaining a high prevalence of porcine T. spiralis infection.

Clonal diversity in the expression and stability of the metastatic capability of Leishmania guyanensis in the golden hamster.

Metastatic disease is a major concern of dermal leishmaniasis caused by Leishmania of the Viannia subgenus. The golden hamster provides an experimental model of systemic dissemination and cutaneous metastasis of Leishmania Viannia. We have exploited this model to examine the expression of parasite virulence in cloned populations derived from a strain of L. guyanensis previously shown to be highly metastatic in the hamster. Metastatic capacity manifested as dissemination throughout the lymphoid organs; cachexia and secondary cutaneous lesions were found to differ among clones, yielding a spectrum of virulence. The metastatic phenotype of clonal populations was stable over 5 sequential passages in hamsters. In addition, the low or high propensity to disseminate and produce cutaneous metastatic lesions was reproduced. Capacity to disseminate from the inoculation site was conserved following subcloning of metastatic clones that had been passaged in culture for several generations; clinical manifestations, cachexia, and cutaneous metastatic lesions were variably expressed. Dissemination of parasites and cachexia were significantly related (P = 0.004). Overall, cachexia was an earlier manifestation of dissemination than cutaneous metastases (P < 0.001). The reproducible expression of virulence phenotypes by discrete populations of Leishmania in the golden hamster provides an experimental model for clinically relevant expression of virulence in human leishmaniasis.

Trichinella spiralis in an agricultural ecosystem: transmission in the rat population.

Four hundred forty-three Norway rats (Rattus norvegicus) were examined to determine their role in the transmission and maintenance of Trichinella spiralis on a pig farm. Rats, classified by sex and weight, were examined for trichinellosis by peptic digestion of muscle samples. Over a 25-mo period, 188 (42.4%) rats were found to be infected with T. spiralis. The mean intensity of infection was 293.2 larvae per gram (LPG) of muscle; 65 (34.6%) infected rats had intensities of infection greater than 100 LPG. Even in the absence of a known source of infected meat (garbage containing meat scraps or dead animals), the rat population maintained the infection, probably through cannibalism. Population reduction was an effective method for reducing the prevalence of infection within the rat population. Therefore, to reduce the likelihood of transmission of T. spiralis between rats and swine, it is essential that rat populations in a farmyard environment be controlled.

Carbohydrate and LPG expression in Leishmania viannia subgenus.

Glycosylated molecules expressed on the cell surface of Leishmania promastigotes contribute to the outcome of contact between the parasite and its invertebrate and vertebrate hosts. The expression of several such molecules is growth phase dependent. Information on the expression of carbohydrates by Leishmania of the Viannia subgenus (braziliensis complex), a widespread cause of morbidity in the Americas, is fragmentary. We have examined the relationship between growth phase and the expression of glycosylated surface structures in WHO reference strains of 3 species of the Viannia subgenus, i.e., L. panamensis, L. guyanensis, and L. braziliensis. Agglutination with lectins and the monoclonal antibody specific for the repeat unit of L. donovani lipophosphoglycan, CA7AE, distinguished logarithmic and stationary-phase promastigotes of all 3 species. Flow cytometry revealed increased heterogeneity and disparity in the expression of the repeat unit epitope in stationary-as compared to logarithmic-phase promastigotes. Biochemical analyses showed the LPG repeat unit of all 3 species reference strains to be constituted by mannose and galactose with little or no substitution and, hence, to be similar to the LPG of L. donovani. Initial quantitative analyses of L. braziliensis LPG indicated a 10-fold lower quantity of LPG in this species than L. donovani and an increase in the size of LPG in the stationary phase. These findings provide bases for isolating and biologically characterizing phenotypically distinct populations of promastigotes and for identifying molecular determinants of the host parasite-relationship among Leishmania Viannia.

Swine trichinosis in New England slaughterhouses.

Diaphragms of 5,315 slaughter hogs from the New England states were examined for Trichinella spiralis infection between June 22 and Dec 22, 1983. Thirty-nine hogs (0.73%) were infected. The infections were light, none exceeding 30 larvae/g of tissue, with an arithmetic mean of 4.7 larvae/g. Infected hogs originated from 5 of 6 New England states. The widespread occurrence of porcine trichinosis in New England indicates that the small or part-time hog farming operations frequently found in this region may be especially vulnerable to the introduction and maintenance of the parasite.

Trichinella spiralis in the black bear (Ursus americanus) of Pennsylvania: distribution, prevalence and intensity of infection.

Samples of tongue or diaphragm from 2,056 black bears harvested in Pennsylvania during the 1981-1983 hunting seasons were examined for larvae of Trichinella spiralis by peptic digestion. Sixteen males and 21 females were infected. The overall prevalence of infection was 1.8%. Infected animals were distributed widely throughout the range of the bear in Pennsylvania. In samples from infected bears, the geometric mean density of muscle larvae was 7.8 per g of tissue (LPG). There were neither sex- nor age-related differences in prevalence or intensity of infection. Virtually all bears harvested in Pennsylvania are consumed as food, which often is shared widely among hunters, their friends and relatives. Furthermore, high densities of larvae occurred in some bears (i.e., 300, 348, 465, 512, 555, and 912 LPG). Thus, a basis for potential, single-source outbreaks of severe human trichinosis exists.

Trichinella spiralis in an agricultural ecosystem. III. Epidemiological investigations of Trichinella spiralis in resident wild and feral animals.

As part of a larger epidemiological study examining the transmission of Trichinella spiralis in an agricultural ecosystem, resident wild and feral animals were trapped to determine the extent of their involvement in the natural, on-farm cycling of the parasite among swine. During a 21-mo-study, seven of 15 skunks (Mephitis mephitis), one of three opossums (Didelphis virginiana), two of two feral domestic cats and a raccoon (Procyon lotor) were found to be infected, while five shrews (Blarina brevicauda) and 18 deer mice (Peromyscus spp.) were uninfected. Most of the former hosts probably became infected by scavenging dead infected swine or rats (Rattus norvegicus). However, infections obtained through predation of living rats, particularly with regard to the cats, cannot be excluded. Our observations do not suggest that there was transmission of T. spiralis from the wild animals to swine. Therefore, transmission of T. spiralis appeared to occur only from the farm's swine and rats to the associated wild and feral animals.