Scrub typhus induced by peripheral blood stem cell transplantation in the immunocompromised patient: diagnostic usefulness of nested polymerase chain reaction

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2010-02, Vol.50 (2), p.467-470
• Main Authors: Kang, Seung‐Ji, Park, Kyung‐Hwa, Jung, Sook‐In, Jang, Hee Chang, Ji, Soo Young, Ahn, Jae Sook, Kim, Hyeoung Joon, Shin, Jong‐Hee, Kim, Dong Min
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Bacterial - blood; Base Sequence; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Bone marrow, stem cells transplantation. Graft versus host reaction; Case reports; Diagnostic Errors; DNA sequencing; DNA, Bacterial - genetics; Female; Fever - etiology; Graft vs Host Disease - diagnosis; Humans; Immunocompromised Host; Immunocompromised hosts; Immunosuppressive Agents - adverse effects; Infectious Disease Incubation Period; Injuries; Leukemia; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - surgery; Living Donors; Male; Medical sciences; Molecular Sequence Data; Orientia tsutsugamushi; Orientia tsutsugamushi - genetics; Orientia tsutsugamushi - immunology; Orientia tsutsugamushi - isolation & purification; Peripheral blood; Peripheral Blood Stem Cell Transplantation - adverse effects; Polymerase chain reaction; Polymerase Chain Reaction - methods; Scrub typhus; Scrub Typhus - diagnosis; Scrub Typhus - microbiology; Scrub Typhus - transmission; Sequence Alignment; Sequence Homology, Nucleic Acid; stem cell transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous - adverse effects
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2009.02442.x

Scrub typhus (Orientia tsutsugamushi) is a Gram‐negative rickettsial disease in parts of Asia, transmitted from wild rodents to human by mites. This is a case report of scrub typhus contraction in an acute leukemia patient by transfusion of peripheral blood stem cells collected during the incubation period. Although human‐to‐human transmission of scrub typhus by needle‐stick injury or transplacental transmission has previously been reported, this is the first case confirmed by polymerase chain reaction (PCR) and DNA sequencing. This type of incident shows the need to heighten awareness of the threat of rickettsial agents in transfused blood. Nested PCR is a useful diagnostic method to confirm the diagnosis during incubation period and in the early phase of disease, especially for immunocompromised patients.