Asymptomatic Donors Research Articles

Multiplex and Genome-Wide Analyses Reveal Distinctive Properties of KIR+ and CD56+ T Cells in Human Blood

Killer cell Ig-like receptors (KIRs) on NK cells have been linked to a wide spectrum of health conditions such as chronic infections, autoimmune diseases, pregnancy complications, cancers, and transplant failures. A small subset of effector memory T cells also expresses KIRs. In this study, we use modern analytic tools including genome-wide and multiplex molecular, phenotypic, and functional assays to characterize the KIR(+) T cells in human blood. We find that KIR(+) T cells primarily reside in the CD56(+) T population that is distinctively DNAM-1(high) with a genome-wide quiescent transcriptome, short telomere, and limited TCR excision circles. During CMV reactivation in bone marrow transplant recipients, KIR(+)CD56(+) T cells rapidly expanded in real-time but not KIR(+)CD56(-) T cells or KIR(+) NK cells. In CMV(+) asymptomatic donors, as much as 50% of CD56(+) T cells are KIR(+), and most are distinguishably KIR2DL2/3(+)NKG2C(+)CD57(+). Functionally, the KIR(+)CD56(+) T cell subset lyses cancer cells and CMVpp65-pulsed target cells in a dual KIR-dependent and TCR-dependent manner. Analysis of metabolic transcriptome confirms the immunological memory status of KIR(+)CD56(+) T cells in contrast to KIR(-)CD56(+) T cells that are more active in energy metabolism and effector differentiation. KIR(-)CD56(+) T cells have >25-fold higher level of expression of RORC than the KIR(+) counterpart and are a previously unknown producer of IL-13 rather than IL-17 in multiplex cytokine arrays. Our data provide fundamental insights into KIR(+) T cells biologically and clinically.

Norovirus Gastroenteritis After Fecal Microbiota Transplantation for Treatment of Clostridium difficile Infection Despite Asymptomatic Donors and Lack of Sick Contacts

Norovirus Gastroenteritis After Fecal Microbiota Transplantation for Treatment of Clostridium difficile Infection Despite Asymptomatic Donors and Lack of Sick Contacts

A population-based epidemiological survey of human parvovirus B19 infection: a project of the Kyushu and Okinawa Population Study (KOPS)

Human parvovirus B19 infection occurs by droplet nuclei through the respiratory tract and causes a wide range of diseases. It can be transmitted through blood transfusion from asymptomatic blood donors. This study was done to investigate the parvovirus B19 infection rate of a group of healthy Japanese residents. Of 2,081 blood samples tested, 15 (0.72%) were positive for parvovirus B19 IgM, 1,412 (67.9%) for B19 virus IgG, and 4 (0.2%) for parvovirus B19 DNA. About half of all women of childbearing age were susceptible to parvovirus B19 infection. No relationship was found between the frequency of symptoms and the prevalence of parvovirus B19 IgG and IgM, suggesting that there are asymptomatic carriers in the healthy Japanese population. There is a risk of parvovirus B19 infection by blood transfusion from asymptomatic donors and that pregnant women are at high risk for parvovirus B19 infection.

Role of MDCT Angiography in Selection and Presurgical Planning of Potential Renal Donors

The purpose of this study was to determine the prevalence and types of renal and extrarenal abnormalities that preclude renal donation or lead to alteration of the surgical approach on the basis of abdominal CT angiography (CTA) in a large group of potential renal donors. In this retrospective study, 654 potential renal donors undergoing dual-phase CTA were identified from January 2005 to January 2009. The CT reports were systemically reviewed by two radiologists to determine the presence of renal and extrarenal abnormalities. The operative notes of the renal donors were reviewed by one radiologist to determine whether the presence of renal pathology had affected the surgical approach. In the candidates who did not proceed to kidney donation, the reasons that precluded kidney donation were abstracted from the transplant database. Four hundred seventeen potential donors (269 men and 385 women; mean age, 44.0 years; age range, 17-79 years) proceeded to renal donation and 237 did not. The most common renal abnormalities were cysts (34%) and renal stones (4.4%). Renal artery disease was identified in 3.4% of potential donors, including renal artery stenosis, possible fibromuscular dysplasia, and renal artery aneurysm. Suspicious renal masses were incidentally found in 0.5% of potential donors. The most common extrarenal pathology was an incidental adrenal nodule (2.6%). Other significant extrarenal pathology identified included gallbladder mass (0.2%), Crohn disease (0.2%), ovarian mass (0.2%), and possible sarcoidosis (0.2%). Although renal and extrarenal abnormalities were present in 41% of potential renal donors, abnormalities seen on CT only contributed to exclusion of 27 potential donors (4.1%). The most common reason for exclusion was the presence of renal stones or scarring (1.8%). Significant CT findings also contributed to the selection of the right kidney in 29 donors, most commonly due to presence of ipsilateral vascular disease or complex left vascular anatomy. Renal parenchymal and vascular abnormalities are common in asymptomatic potential kidney donors. Although most of these represent incidental CT findings, abnormalities can exclude potential renal donors and alter the surgical approach in a small minority of cases.

Non-O blood group: an important genetic risk factor for venous thromboembolism.

Non-O blood group: an important genetic risk factor for venous thromboembolism.

The utility of pathogen inactivation technology: a real-life example of Leishmania infantum inactivation in platelets from a donor with an asymptomatic infection.

Visceral leishmaniasis is typically caused by Leishmania infantum (L. infantum) in the Mediterranean littoral. The majority of infections with L. infantum are asymptomatic and resolve spontaneously in individuals with normal immune systems. A minority progress to classic, full-blown visceral leishmaniasis, known in many areas as kalaazar1,2. Leishmania infection is most often transmitted to humans via the bite of the phlebotomine female sand fly, however transmission of Leishmania by transfusion has also been reported3–13. Populations at risk of clinically apparent disease caused by L. infantum after insect bites or transfusion include infants and immunosuppressed patients. Most cases of transfusion-transmitted leishmaniasis have been reported in endemic areas and, because the infection is often asymptomatic in healthy individuals, it is difficult to calculate the transmission risk precisely. The existence of cryptic Leishmania infections, associated with intermittent low density circulation of the parasite 1,14, has been the main cause of transmission by blood. In the Balearic Islands, our region, the prevalence of asymptomatic L. infantum infection in blood donors is high (11% of blood donors tested had a positive reaction to the delayed-type hypersensitivity test, 3.1% had specific antibodies and L. infantum DNA was detected in the blood of 5.9% of donors studied)15 which is in agreement with other findings regarding asymptomatic individuals from the Mediterranean region1,16,17. Although some research studies have investigated Leishmania infection in blood donors1,14–17, currently there is no suitable Leishmania donor screening test that meets Blood Bank requirements with respect to aspects such as speed, automation and standardisation. At present, the only measure applied to prevent transmission-transfusion leishmaniasis is based on donor selection criteria. According to the “Guide to Preparation, Use and Quality Assurance of Blood Components” from the European Committee on Blood Transfusion, as well as the Spanish Regulation on Blood Donation, the strategy adopted in Europe is based on permanent deferral for donors who have had or currently have visceral leishmaniasis. In other countries, such as the USA, donors are deferred for a period of 1 year from the date of their last departure from an endemic country. Since there is currently no adequate donor screening test for Leishmania, several methods have been used to inactivate Leishmania in blood products18–20 and to eliminate the parasites through filtration using whole blood, fresh plasma and red blood cell (RBC) leucodepletion systems15,21–23. As an approach to reducing the risk of transfusion-related transmission in our area, we investigated the ability of pathogen inactivation technology using riboflavin and ultraviolet light to eliminate L. infantum in apheresis platelet units obtained from an asymptomatic infected blood donor. This is the first report on the utility of pathogen inactivation technology in the elimination of a parasite from a blood component collected from an asymptomatic infected blood donor.

Utility of the Microculture Method in Non-Invasive Samples Obtained from an Experimental Murine Model with Asymptomatic Leishmaniasis

The sensitivity of diagnostic methods for visceral leishmaniasis (VL) decreases because of the low number of parasites and antibody amounts in asymptomatic healthy donors who are not suitable for invasive sample acquisition procedures. Therefore, new studies are urgently needed to improve the sensitivity and specificity of the diagnostic approaches in non-invasive samples. In this study, the sensitivity of the microculture method (MCM) was compared with polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), and immunofluorescent antibody test (IFAT) methods in an experimental murine model with asymptomatic leishmaniasis. Results showed that the percent of positive samples in ELISA, IFAT, and peripheral blood (PB) -PCR tests were 17.64%, 8.82%, and 5.88%, respectively, whereas 100% positive results were obtained with MCM and MCM-PCR methods. Thus, this study, for the first time, showed that MCM is more sensitive, specific, and economic than other methods, and the sensitivity of PCR that was performed to samples obtained from MCM was higher than sensitivity of the PCR method sampled by PB.

Highly Efficient Prion Transmission by Blood Transfusion

It is now clearly established that the transfusion of blood from variant CJD (v-CJD) infected individuals can transmit the disease. Since the number of asymptomatic infected donors remains unresolved, inter-individual v-CJD transmission through blood and blood derived products is a major public health concern. Current risk assessments for transmission of v-CJD by blood and blood derived products by transfusion rely on infectious titers measured in rodent models of Transmissible Spongiform Encephalopathies (TSE) using intra-cerebral (IC) inoculation of blood components. To address the biological relevance of this approach, we compared the efficiency of TSE transmission by blood and blood components when administrated either through transfusion in sheep or by intra-cerebral inoculation (IC) in transgenic mice (tg338) over-expressing ovine PrP. Transfusion of 200 µL of blood from asymptomatic infected donor sheep transmitted prion disease with 100% efficiency thereby displaying greater virulence than the transfusion of 200 mL of normal blood spiked with brain homogenate material containing 103ID50 as measured by intracerebral inoculation of tg338 mice (ID50 IC in tg338). This was consistent with a whole blood titer greater than 103.6 ID50 IC in tg338 per mL. However, when the same blood samples were assayed by IC inoculation into tg338 the infectious titers were less than 32 ID per mL. Whereas the transfusion of crude plasma to sheep transmitted the disease with limited efficacy, White Blood Cells (WBC) displayed a similar ability to whole blood to infect recipients. Strikingly, fixation of WBC with paraformaldehyde did not affect the infectivity titer as measured in tg338 but dramatically impaired disease transmission by transfusion in sheep. These results demonstrate that TSE transmission by blood transfusion can be highly efficient and that this efficiency is more dependent on the viability of transfused cells than the level of infectivity measured by IC inoculation.

Differential Expression of Toll-Like Receptor 2 on Dendritic Cells from Asymptomatic and Symptomatic Atopic Donors

Background: Early microbial exposure may reduce the risk for developing allergies on an atopic genetic background. Toll-like receptors (TLRs) recognize pathogen-associated molecular patterns of microbes and modulate innate and adaptive immunity. Different expression of TLRs in symptomatic and asymptomatic atopic donors may contribute to the development of allergic disease. Methods: Monocytes and monocyte-derived dendritic cells (DCs) from symptomatic (n = 12) and asymptomatic atopic donors (n = 11), healthy nonatopics (n = 14) and from patients with psoriasis (n = 13) were analyzed for their expression of TLR2, TLR4 and TLR9 by real-time PCR. Results: Monocytes did not show any differences in TLR2, TLR4 and TLR9 expression between the 4 groups. In contrast, DCs from asymptomatic donors showed an enhanced expression of TLR2 over DCs from nonatopics (p = 0.038) and just failed to reach significance when compared to symptomatic atopic patients (p = 0.060). TLR2 expression kinetics from monocytes to monocyte-derived DCs showed sustained expression of TLR2 in DCs only from asymptomatic donors but downregulation in the other groups. In DCs from symptomatic atopic donors, the expression of TLR2 correlated significantly with total IgE values in the serum (p = 0.01994). Conclusion: Differential expression and functional regulation of TLR2 expression by DCs from symptomatic and asymptomatic atopic donors may be important for the manifestation of allergic disease. Increased and sustained TLR2 expression on DCs, possibly as a result of an increased exposure to microorganisms or as a mechanism enhancing the sensitivity of microbe detection, may be of functional importance for the maintenance of clinical unresponsiveness toward allergens.

Peripheral blood stem cell transplant–related Plasmodium falciparum infection in a patient with sickle cell disease

Although transmission of Plasmodium falciparum (Pf) infection during red blood cell (RBC) transfusion from an infected donor has been well documented, malaria parasites are not known to infect hematopoietic stem cells. We report a case of Pf infection in a patient 11 days after peripheral blood stem cell transplant for sickle cell disease. Malaria parasites were detected in thick blood smears by Giemsa staining. Pf HRP2 antigen was measured by enzyme-linked immunosorbent assay on whole blood and plasma. Pf DNA was detected in whole blood and stem cell retention samples by real-time polymerase chain reaction using Pf species-specific primers and probes. Genotyping of eight Pf microsatellites was performed on genomic DNA extracted from whole blood. Pf was not detected by molecular, serologic, or parasitologic means in samples from the recipient until Day 11 posttransplant, coincident with the onset of symptoms. In contrast, Pf antigen was retrospectively detected in stored plasma collected 3 months before transplant from the asymptomatic donor. Pf DNA was detected in whole blood from both the donor and the recipient after transplant, and genotyping confirmed shared markers between donor and recipient Pf strains. Lookback analysis of RBC donors was negative for Pf infection. These findings are consistent with transmission by the stem cell product and have profound implications with respect to the screening of potential stem cell donors and recipients from malaria-endemic regions.

A case report of transfusion-transmitted Plasmodium vivax malaria from an asymptomatic donor to a premature newborn

Most of the Colombian territory is endemic for malaria. Autochthonous cases with low parasitemia occur in the Pacific coast and in large zones of Antioquia and Córdoba. According to the Colombian legislation no malaria screening test is mandatory for blood donors from non-endemic areas. However, if they have traveled to malaria transmission regions they are deferred for six months before they can donate. This report describes a transfusion- transmitted malaria case in Cali (Valle del Cauca, Colombia), where a preterm newborn received infected blood from a donor that lived in the same city, but he had traveled to the rural area of the municipality of Dagua (Valle del Cauca, Colombia) 9 months before the donation. Thick blood smears confirmed Plasmodium vivax infection in the newborn and the donor sample was analyzed by PCR, which confirmed P. vivax infection. This case suggests the need for reviewing donor selection criteria and deferral strategies to prevent possible cases of transfusion-transmitted malaria.

A case report of transfusion-transmitted Plasmodium vivax malaria from an asymptomatic donor to a premature newborn

Gran parte del territorio colombiano es endémico para malaria; sin embargo, los casos autóctonos con parasitemia baja se presentan principalmente en el área del Litoral Pacífico y zonas extensas de Antioquia y Córdoba.Según la legislación colombiana, no se requiere ninguna prueba obligatoria para el diagnóstico de malaria en los donantes de sangre de las áreas no endémicas. No obstante, si los donantes potenciales han viajado a las regiones endémicas, son diferidos por seis meses antes de que puedan donar. Este reporte describe un caso de malaria transmitida por transfusión en Cali (Valle del Cauca, Colombia), en el que un recién nacido prematuro recibió hemoderivados infectados de un donante que vivía en la misma ciudad que viajó a la zona rural de Dagua (Valle del Cauca) nueve meses antes de la donación. La prueba de la gota gruesa confirmó la enfermedad por Plasmodium vivax en el recién nacido y la muestra del donante se sometió a reacción en cadena de la polimerasa (PCR), que fue positiva para la misma especie.Este caso sugiere la necesidad de revisar los criterios de selección de donantes y las estrategias de aplazamiento, para evitar posibles casos de malaria transmitida por transfusión.

How Can the Blood Transfusion Medicine Community Contribute to Public Health in Tough Economic Times?

the major source of the residual risk of transfusion-transmitted infections. The rates and characteristics of these infections inform decisions about further safety interventions. These data can also validate and supplement public health surveillance; for example, the real-time tracking of largely asymptomatic donor West Nile virus infections, with coverage of the entire country, often provides the earliest evidence of human activity in a region. In this issue of the Journal of Infectious Diseases, 2 articles add to the body of information generated through analysis of sample repositories from blood donors. These studies suggest that we may be underusing the resource that donors represent for the study of infectious diseases in the United States and globally. Even before the recent H1N1 pan

Schistosoma mansoni infection in the liver graft: The impact on donor and recipient outcomes after transplantation

The increasing number of transplants performed each year has led to the identification of unusual diseases in liver grafts from asymptomatic donors that were unrecognized before liver transplantation. Here we report our experience with patients who received liver grafts infected with schistosomiasis. From September 1991 to August 2010, 482 pediatric liver transplants were performed at A. C. Camargo Hospital/Sírio-Libanês Hospital (São Paulo, Brazil). For the identification of Schistosoma mansoni infections, pathology slides for the recipients were reviewed; these included postreperfusion and follow-up liver biopsy samples. We were able to identify 6 cases of schistosomiasis transmitted through infected grafts (5 of these grafts were from living donors). All living donors were confirmed to have normal liver chemistries, negative fecal tests for parasitic diseases, and normal abdominal ultrasound findings. Liver biopsy was not performed before transplantation. In all cases, features of schistosomiasis were absent in the liver explants. The living donors were treated with praziquantel and were taught to avoid risk factors for reinfection. No specific treatment for schistosomiasis was given to the recipients. There were no perioperative deaths, but 2 recipients died after living donor liver transplantation (LDLT) because of Kaposi's sarcoma and non-Hodgkin's lymphoma. In conclusion, using liver grafts infected with S. mansoni eggs did not compromise the results of LDLT in this pediatric cohort. Because of the parasite's life cycle and the therapeutic target of praziquantel, only donors should be treated for the infection. Three years of follow-up showed an uneventful recovery for the living donors.

Pathogen inactivation

Pathogen inactivation

Development of real-time PCR assay for differential detection and quantification for multiple Babesia microti-genotypes

We have developed a real-time PCR assay that can rapidly and differentially detect and quantify four genotypes of small subunit ribosomal RNA gene (SSUrDNA) of Babesia microti (Kobe-, Otsu-, Nagano- and US-types). In this assay, four genotype-specific pairs of primers targeted on internal transcribed spacer (ITS) 1 or 2 sequences were used and amplicons by each pair of primers were quantitatively detected by fluorescent SYBR Green I. The four genotype-specific pairs of primers displayed the high specificity for homologous genotype DNA. The standard curves of cycle threshold (Ct) values versus amount of target DNA per reaction (log) for all four genotypes were linear and the correlation coefficient (Rsq) values for the curves were from 0.970 to 0.997. The standard curves were almost identical even in the presence of heterologous genotype DNA. This assay could detect 10–30 fg purified DNA (equivalent to the amount of 1–5 parasite DNA) of each genotype B. microti. This assay could also detect each genotype B. microti infection in blood with 3 × 10 − 6 %–1 × 10 − 5 % parasitemia. This assay was applicable to field rodent and tick samples to reveal mixed infection in several samples, for which a single genotype of B. microti had been detected by direct sequencing analyses in our previous studies. This assay also seemed to be applicable to clinical human samples, showing Kobe-type positive results for the first Japanese babesiosis patient and the asymptomatic donor, both infected with Kobe-type B. microti.

Recipient of kidney from donor with asymptomatic infection byParacoccidioides brasiliensis

The increase in solid organ transplantations may soon create a rise in the occurrence of endemic fungal diseases, such as paracoccidioidomycosis, due to the lack of rigorous screening of donors from endemic areas. Here we present the first case of an immunocompetent and asymptomatic kidney donor who had Paracoccidioides brasiliensis infected-adrenal tissue but no glandular dysfunction.

The role of synovial fluid markers of catabolism and anabolism in osteoarthritis, rheumatoid arthritis and asymptomatic organ donors

IntroductionThe purpose of this study was to correlate the level of anabolic and catabolic biomarkers in synovial fluid (SF) from patients with rheumatoid arthritis (RA), patients with osteoarthritis (OA) and asymptomatic organ donors.MethodsSF was collected from the knees of 45 OA, 22 RA patients and 20 asymptomatic organ donors. Eight biomarkers were selected and analyzed by using an enzyme-linked immunosorbent assay: interleukin (IL)-1, IL-6, IL-8 and IL-11; leukemia-inhibitory factor (LIF); cartilage oligomeric protein (COMP); osteocalcin; and osteogenic protein 1 (OP-1). Data are expressed as medians (interquartile ranges). The effects of sex and disease activity were assessed on the basis of the Western Ontario and McMaster Universities index score for patients with OA and on the basis of white blood cell count, erythrocyte sedimentation rate and C-reactive protein level for patients with RA.ResultsThe mean ages (± SD) of the patients were as follows: 53 ± 9 years for patients with OA, 54 ± 11 years for patients with RA and 52 ± 7 years for asymptomatic organ donors. No effect of participants' sex was identified. In the SF of patients with RA, four of five cytokines were higher than those in the SF of patients with OA and those of asymptomatic organ donors. The most significant differences were found for IL-6 and IL-8, where IL-6 concentration in SF of patients with RA was almost threefold higher than that in patients with OA and fourfold higher than that in asymptomatic donor controls: 354.7 pg/ml (1,851.6) vs. 119.4 pg/ml (193.2) vs. 86.97 pg/ml (82.0) (P < 0.05 and P < 0.05, respectively). IL-8 concentrations were higher in SF of patients with RA than that in patients with OA as well as that in asymptomatic donor controls: 583.6 pg/ml (1,086.4) vs. 429 pg/ml (87.3) vs. 451 pg/ml (170.1) (P < 0.05 and P < 0.05, respectively). No differences were found for IL-11 in the SF of patients with RA and that of patients with OA, while a 1.4-fold difference was detected in the SF of patients with OA and that of asymptomatic donor controls: 296.2 pg/ml (257.2) vs. 211.6 pg/ml (40.8) (P < 0.05). IL-1 concentrations were the highest in the SF of RA patients (9.26 pg/ml (11.1)); in the SF of asymptomatic donors, it was significantly higher than that in patients with OA (9.083 pg/ml (1.6) vs. 7.76 pg/ml (2.6); P < 0.05). Conversely, asymptomatic donor control samples had the highest LIF concentrations: 228.5 pg/ml (131.6) vs. 128.4 pg/ml (222.7) in the SF of patients with RA vs. 107.5 pg/ml (136.9) in the SF of patients with OA (P < 0.05). OP-1 concentrations were twofold higher in the SF of patients with RA than those in patients with OA and threefold higher than those in asymptomatic donor control samples (167.1 ng/ml (194.8) vs. 81.79 ng/ml (116.0) vs. 54.49 ng/ml (29.3), respectively; P < 0.05). The differences in COMP and osteocalcin were indistinguishable between the groups, as were the differences between active and inactive OA and RA.ConclusionsActivation of selected biomarkers corresponds to the mechanisms that drive each disease. IL-11, LIF and OP-1 may be viewed as a cluster of biomarkers significant for OA; while profiling of IL-1, IL-6, IL-8, LIF and OP-1 may be more significant in RA. Larger, better-defined patient cohorts are necessary to develop a biomarker algorithm for prognostic use.

Detection of Prion Protein in Urine-Derived Injectable Fertility Products by a Targeted Proteomic Approach

BackgroundIatrogenic transmission of human prion disease can occur through medical or surgical procedures, including injection of hormones such as gonadotropins extracted from cadaver pituitaries. Annually, more than 300,000 women in the United States and Canada are prescribed urine-derived gonadotropins for infertility. Although menopausal urine donors are screened for symptomatic neurological disease, incubation of Creutzfeldt-Jakob disease (CJD) is impossible to exclude by non-invasive testing. Risk of carrier status of variant CJD (vCJD), a disease associated with decades-long peripheral incubation, is estimated to be on the order of 100 per million population in the United Kingdom. Studies showing infectious prions in the urine of experimental animals with and without renal disease suggest that prions could be present in asymptomatic urine donors. Several human fertility products are derived from donated urine; recently prion protein has been detected in preparations of human menopausal gonadotropin (hMG).Methodology/Principal FindingsUsing a classical proteomic approach, 33 and 34 non-gonadotropin proteins were identified in urinary human chorionic gonadotropin (u-hCG) and highly-purified urinary human menopausal gonadotropin (hMG-HP) products, respectively. Prion protein was identified as a major contaminant in u-hCG preparations for the first time. An advanced prion protein targeted proteomic approach was subsequently used to conduct a survey of gonadotropin products; this approach detected human prion protein peptides in urine-derived injectable fertility products containing hCG, hMG and hMG-HP, but not in recombinant products.Conclusions/SignificanceThe presence of protease-sensitive prion protein in urinary-derived injectable fertility products containing hCG, hMG, and hMG-HP suggests that prions may co-purify in these products. Intramuscular injection is a relatively efficient route of transmission of human prion disease, and young women exposed to prions can be expected to survive an incubation period associated with a minimal inoculum. The risks of urine-derived fertility products could now outweigh their benefits, particularly considering the availability of recombinant products.

Isolation of Streptococcus bovis from apheresis platelets of asymptomatic donor warranted colonoscopy investigation: case report and literature review

Bacterial contamination of platelet (PLT) products is one of the most serious complications of transfusion. Culturing PLT components may detect the presence of bacteria, thus reducing the risk of a septic result after transfusion. Streptococcus bovis has previously been reported as a contaminating microorganism in PLT products. Here we report an asymptomatic donor diagnosed with occult colon malignancy after positive isolation of S. bovis from his apheresis PLTs (APs). We also review previous cases. The PLT donor was a 50-year-old man with more than 150 prior plateletpheresis or whole blood donations. Bacterial culture of his AP components yielded two positive results: group D Streptococcus was isolated in July 2008 and S. bovis was reported in April 2010. The donor received further testing, and colonofibroscopic examination revealed colonic neoplasm. Pathologic examination of the biopsied tissue led to a diagnosis of invasive adenocarcinoma. He underwent a left hemicolectomy in July 2010. Examination of the resection specimen confirmed adenocarcinoma, Stage III with regional lymph node metastatic adenocarcinoma. Donated AP products positive for S. bovis should not be presumed to be due to contamination during collection. This bacteremia originating from donor factors needs to be carefully evaluated. Colonofibroscopic examination is recommended for these donors to detect colonic malignancy as early as possible.