[Chagas disease and blood transfusion: an emerging issue in non-endemic countries]. / Maladie de Chagas et transfusion sanguine: un problème parasitaire émergent dans les pays non endémiques.

Chagas disease or American human trypanosomiasis, is a parasitic disease due to Trypanosoma cruzi, which is endemic in Latin America. The parasite is transmitted by haematophagous vectors from reduviidae family. In some patients, the parasite is responsible for severe complications such as cardiac manifestations, gastrointestinal involvement and neurologic disease. Imported Chagas disease by immigration in non-endemic countries poses the threat of the infection transmission by blood transfusion. In order to prevent this risk, the French Blood Services (EFS) introduced systematic screening of at-risk blood donors for anti-T. cruzi antibodies, in May 2007. The concerned donors are people originating from an endemic area, donors with mothers originating from such an area and individuals who had lived in or travelled to endemic areas. Donors were screened with two different Elisas simultaneously: one Elisa using purified parasite lysate antigens and the second one composed of recombinant antigens. Positive results and discrepant results were further assayed with an immunofluorescence assay. A seroprevalence assay was performed in the 17 French blood centres after an 18-month testing period from May 2007 to December 2008. During this period 4,637,479 million donations were collected. Out of these 163,740 donations were tested (3.5%). The prevalence of anti-T. cruzi antibodies was one in 32,800 donations. Five positive donors were identified. All of them were originating from endemic areas. A rate of 0.85% indeterminate results was found. Screening strategy revision was decided to reduce the number of donors unnecessarily deferred.

Prevalence of hepatitis G virus RNA in French blood donors and recipients.

BACKGROUND: Recently, cases of chronic hepatitis were linked to the presence of genomic sequences of a newly described RNA virus termed hepatitis G virus (HGV) and belonging to the Flaviviridae family. STUDY DESIGN AND METHODS: The presence of HGV RNA was searched for by polymerase chain reaction in a population of blood donors and in patients who had received multiple blood component transfusions and/or intravenous immunoglobulin (IVIG) infusions. RESULTS: Twenty-one (4.2%) of 500 donors were positive for HGV RNA as were 21 (10.7%) of 196 nonimmunosuppressed patients who had received multiple transfusions of packed red cells, 4 (8.7%) of 46 common variable immune deficiency (CVID) patients who had received only IVIG, and 22 (24.7%) of 89 bone marrow transplant (BMT) patients who had received IVIG and cellular components. The proportion of HGV-positive individuals was significantly higher in the immunosuppressed recipients (CVID and BMT patients) than in the nonimmunosuppressed patients who were multiply transfused with packed red cells (p < 0.03). The proportion of HGV-positive individuals was significantly higher in the BMT patients who had received IVIG and cellular components than in the CVID patients who had received IVIG only (p < 0.03). Eight (17.0%) of the 47 HGV-positive recipients and 48 (16.9%) of the 284 HGV-negative recipients had a serum alanine aminotransferase level higher than the upper limit of normal (nonsignificant difference). The medical history of HGV-positive donors failed to reveal a particular at-risk event. The large majority of HGV-infected patients had a normal serum alanine aminotransferase level, and the proportion of patients with elevated alanine aminotransferase was the same in HGV-positive and in HGV-negative recipients. CONCLUSION: The pathological significance of HGV infection remains unelucidated, and the classification of HGV as a new hepatitis virus was perhaps premature.

Prevalence and clinical features of hepatitis G virus infection in bone marrow allograft recipients.

To study the prevalence and clinical features of hepatitis G virus (HGV)/GB virus C (GBV-C) infection in bone marrow transplantation (BMT), we examined frozen serum samples from 95 bone marrow allograft patients for HGV/GBV-C RNA by RT-PCR. Twenty-eight out of 95 (29.5%) were positive and 14 of the HGV+ patients were already positive before transplantation. The mean numbers of blood donors to whom the HGV and HGV+ populations were exposed before BMT were not significantly different (Kruskal-Wallis test, P = 0.08, NS) but did reveal that the HGV+ population had been transfused more often. Moreover, all but one of the patients who were HGV+ before graft, had had hematological diseases which needed heavy transfusion protocols suggesting, a role of blood products in HGV transmission. Fifty out of the 95 patients received Gammagard intravenous immunoglobulin (i.v.IG) batches suspected of having transmitted HCV. However, no significant difference appeared between these recipients and those receiving other i.v.IG. Despite their immunodeficiency, no clinical or biological evidence of liver disease potentially linked to HGV infection has as yet been observed. The clinical outcome, in terms of acute GVHD, chronic GVHD or veno-occlusive disease was similar in HGV+ and HGV- recipients suggesting the absence of adverse effects of HGV infection on the early outcome of allogenic BMT. Long-term evolution remains to be prospectively studied.