American trypanosomiasis (Chagas' disease) and blood banking in Mexico City: seroprevalence and its potential transfusional transmission risk

Abstract

Background: American trypanosomiasis (Chagas' disease), an anthropozoonosis fairly common in rural Latin America, has become an urban disease due to continuous migration, intra- and internationally. Blood transfusion, the second important pathway for transmission, increases its impact. Recognition of seropositive subjects among blood donors is now recommended, and clinical and serological screening enforced. Maneuvers to inactivate or remove Trypanosoma cruzi present in collected blood are recommended.

Methods: We surveyed voluntary donors at the National Institute of Cardiology in Mexico City in search of anti-T. cruzi by indirect immunofluorescence, ELISA, and Western blot analysis. Seropositive donors were identified and tested for immunoglobulin. We used types and fractions of donated blood to extract DNA and perform the PCR technique using kinetoplast primers seeking parasite DNA in blood.

Results: After 3,300 donors were screened, we identified 10 seropositive subjects (0.3%). These subjects were considered as indeterminate chagasic patients, came mainly from rural areas, and had IgG (100%) and IgA (30%) antibodies against a crude extract as well as a recombinant T. cruzi antigen. Identification of parasite DNA in red cell and platelet fraction was achieved from eight blood units.

Conclusions: The present data provide evidence that blood donors at an urban hospital are seropositive for T. cruzi and at least 50% of donors carry the parasite potentially able to transmit T. cruzi in their cellular blood products. Serological screening should be included in routine blood-making. It is also necessary to adopt measures to inactivate or eliminate organisms in donated blood.