Acute Chagas' disease in a European stem cell transplant recipient

Abstract number: P2192

Martin-Rico P., Perez de Pedro I., Cuesta-Casas M.A., Faez-Herrera Y., Pascual-Gascon M.J., Porras-Ballesteros J., Blanch-Iribarren P., Villarta-Camacho M.C., Muñoz Perez M.I., Heiniger-Mazo A.I., Colmenero-Castillo J.D.

Objective: We report a recent case of acute transfusion-acquired Chagas disease in a bone-marrow transplant recipient in Spain.

Chagas disease is a major public health problem in endemic areas of South America. Untreated immigrants from endemic areas are a potential source of infection and spreading to nonendemic areas mainly via infected blood products used in transfusions.

Acute transfusional cases in immunosuppressed patients can be fatal unless early recognised and treated.

Methodology: Case report. A 33-year-old male patient received an allogeneic stem-cell transplantation (11/05/07) from a related donor because of bone-marrow aplasia diagnosed 2 months earlier. He received several blood transfusions (both red cells and platelets) before and after the procedure. On the 9th day after transplantation spiky fever developed, followed by blurred vision and palpebral edema, which quickly progressed to facial edema and erythema with palpebral purplish discolouration. All microbiological and radiological screening was negative. Fever persisted despite extensive empirical antibiotic and antifungal treatment. Erythema and edema became generalised and a skin biopsy was performed showing Trypanosoma cruzi amastigotes. Direct microscopy (×1000 magnification) of thick fresh blood showed motile trypomastigotes, also visible in Giemsa stained thin blood film (Fig. 1).

Figure 1.

PCR was positive for Trypanosoma cruzi in blood, bone-marrow, skin and urine. Chagas serology was negative. Neither the patient nor the donor had ever visited endemic Chagas areas.

Benznidazole, 300 mg qd, was started. Fever resolved in 7 days and visible parasitaemia disappeared in 10 days. PCR became negative in one month. Edema did gradually regressed. Treatment was completed with no major toxicity.

Tranfusional Chagas disease was then searched. Two months before stem cell transplantation, the patient had received platelets from an asymptomatic Bolivian donor, with positive Chagas serology.

Conclusions:

1In the era of globalisation Chagas Disease has to be considered in the diagnosis of persistent fever in severely immunosuppressed patients.

2Fever and facial edema and erythema were the most striking symptoms. Diagnosis is easy when the disease is focused and searched

3Nonendemic areas must accelerate full implementation of a mandatory screening of blood donors from endemic areas, including organ donors and recipients. Immigrant pregnant women should also be screened to further prevent vertical transmission