Blood globally after revelation of Transfusion Transmissible Infections

Topic: HealthCancer
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Last updated: August 21, 2019

Blood transfusion is a life-saving intervention andmillions of lives are saved each year globally through this procedure.

However,blood transfusions are associated with certain risks which can lead to adverseconsequences. It may cause acute or delayed complications and carries the riskof the transmission of infections. Globally, more than 81 million units ofblood are donated each year . (Manzoor  et al., 2009)Bloodtransfusion is a therapeutic procedure, as there is no genuine substitution.

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But contaminated blood transfusion can transmit infectious diseases and can befatal instead of saving life.Safety and protection of human life are two majorpoints adopted in blood transfusion globally after revelation of TransfusionTransmissible Infections (TTIs) .(Tessema et al.

, 2010)Transfusiontransmissible infections can be classified as viral, bacterial and parasiticinfections. The most commonly encountered transfusion infection is of viralorigin. In many cases, post transfusion diseases have been caused by humanimmunodeficiency virus (HIV), hepatitis B and C virus.(Ameevero et al., 2013) 1.2 STDs & SYPHILIS:Oneof the main threats to humanity are Sexually Transmitted Diseases (STD’s) thosecan lead to persistent disability, infertility issues, stillbirth, seriousneonatal infections and can also be fetal.

Infections caused by STD’s like syphilisincrease the chances of acquiring Human Immunodeficiency Virus (HIV) throughsexual contact.  (Faseehaye  et al., 2011) Syphilisis a sexually transmitted diseases (STD). It is not as common as some sexuallytransmitted infections but if left untreated it can cause very serious healthproblems in both men and women.and can also be transferred down from mother tobaby.(Bhawani  et al.

, 2010)Syphilisis caused by bacteria known as Treponemapallidum which belongs to spirochete group of bacteria.  This is easily passed from one person toanother through sexual contact. Bothmen and women can have syphilis, and pass it on because symptoms can be mildand person  may not notice or recognisethem. Following mode  may spreadinfections:?      Sexualcontact?      Pregnantwomen to their child?       Blood Transfusion.(Bhawani et al., 2010) Syphilisresults from infection by the corkscrew-shaped bacterium, Treponema pallidum.

Initial inoculation occurs via visible or microscopic abrasions of the skin ormucous membranes which can result from sexual contact. The average incubationperiod of syphilis (ie. time from exposure to the development of primarysyphilis) is 3 weeks but can be as long as 3 months and as short as 9-10days.(Minde et al.

,, 1989) Some inoculating organisms lodge at the siteof entry, proliferate and sensitize lymphocytes and macrophages, resulting inthe development of a primary syphilis lesion or “chancre” – a dermatologiclesion which progresses from macule to papule to ulcer, typically remaining painless,demonstrating induration and a nonpurulent base. Multiple chancres are noted inup to 40% of primary syphilis cases (Chapel et al., 1978) Thechancre heals spontaneously, usually without scarring, within 1-6 weeks,heralding the end of the primary stage. After hematogenous dissemination,generalized or local skin and mucous membrane eruptions can occur, oftenaccompanied by generalized lymphadenopathy and constitutional symptoms,signaling the onset of secondary syphilis.

Lesions of secondary syphilisgenerally occur 3-6 weeks after the appearance of the primary ulcer but up toone third of patients with signs of secondary syphilis have a primary lesionstill present at the time of diagnosis (Chapel et al., 1980) The rash of secondary syphilis is nonspecificin appearance (ie. macular, papular, or any combination), with usuallynonpruritic lesions scattered on the trunk and extremities and involves thepalms and soles (discrete, scaly, oval lesions) in more than half of cases.

 Other findings of secondary syphilis includemucous patches (flat, silver-grey erosions involving the mouth, pharynx,larynx, genitals, or anus), condyloma lata (moist, grey-white, wartlike growthsappearing on the genitals, perianal area, and perineum, in gluteal folds, nasolabialfolds, axillae, between toes, and under breasts), and patchy alopecia whichoften has a moth-eaten appearance.(Bailey and Love’s short practiceof surgery : 27th Ed )  Secondary syphilis (ie. condyloma lata) shouldbe included in the differential diagnosis of any lesion with the appearance ofcondyloma acuminata (ie. Human Papillomavirus infection), and a syphilisserology should be performed when treating any anogenital wart. Many cases ofsecondary syphilis have nontreponemal serologic titers in the range of 1:128 orhigher, although in general, the height of the titer should not be used forstaging purposes.(Taseem et al., 2010) Symptoms of secondary syphilis may persistweeks to months before spontaneously remitting, even without treatment. Arelapse of secondary signs/ symptoms can occur, usually during the first yearof infection.

The host immune response suppresses infection enough to eliminateany signs or symptoms of disease, but does not eradicate the infectioncompletely, resulting in latent stage infection. During latency, either earlylatent (duration of infection ? 1 year) or late latent (> 1 year), noclinical manifestations are evident, and infection can only be detected byserologic screening.Thenatural history of late latent syphilis in the immunocompetent patient followsthe rule of thirds: one third of patients will sero-revert to a nonreactivenontreponomal syphilis serology, with no recurrence of disease; one third willremain reactive by nontreponomal syphilis serology but remain free of symptomsor signs of disease; and the remaining one third will go on to develop tertiarysyphilis, sometimes after decades of chronic, persistent, asymptomaticinfection.

Patients with tertiary syphilis may develop granulomatous lesions(gummas) of the skin or viscera, cardiovascular disease (including aorticaneurysm, aortic valve insufficiency, coronary stenosis, and myocarditis), orneurologic disease (acute meningitis, meningovascular disease, general paresis,tabes dorsalis, and gummatous disease of the brain and spinal cord).(French etal., 2011)  Therefore, untreated syphilis can ultimatelylead to devastating, irreversible sequelae which include the complications ofneurosyphilis and tertiary syphilis. In addition, untreated syphilis infectionin a pregnant woman can have tragic consequences for a developing fetus whentransmitted in utero (ie. congenital disease). It has also become wellrecognized that STDs such as syphilis interact synergistically with HIV.

Thelikelihood of HIV acquisition by an HIV-negative individual is markedlyincreased in the presence of syphilis or other sexually transmitted infections(Quinn et al., 1990). Similarly, in the presence of a genital ulcer, personsinfected by HIV more effectively transmit HIV to uninfected partners(Hutchinson et al., 1991)Althoughsusceptibility to syphilis re-infection is decreased immediately after anepisode of adequately treated infection, any acquired immunity is short-livedafter which time, exposure can result in reinfection. Therefore a person canbecome re-infected multiple times over their sexually active lifetime and eachinfection may have a similar natural history, passing through the primary,secondary, and latent stages, as described above.

Chronicsyphilis includes primary and secondary stages and acute stage is referred astertiary stage. Syphilis becomes fetal in the tertiary stage of its infections.The most susceptible organs for the TreponemaPalladium are oral and genital mucous membrane.

Syphilis is a prevalent STDin both developed and developing countries. (Allain et al., 2009)Mostpeople with syphilis have no recognizable symptoms. If symptoms areexperienced, they can include rashes (especially on the palms of the hands andsoles of the feet).

Painless, open sores called chancres (pronounced”shankers”) can appear on the penis, the anus, inside or outside the vagina, onthe mouth or lips, or on any skin exposed during sex. Other symptoms includepatchy hair loss, fever, swollen lymph glands, muscle aches, and fatigue.Symptoms (when they are noticed) usually last several weeks and disappear, evenwithout treatment. Although the symptoms go away, syphilis infection remains inthe body. If left untreated, over the years, syphilis can permanently andseriously damage the heart, brain, and nervous system. (Robbins basic pathology 8thed.

)Antibioticscan cure syphilis, often in a single dose. To be cured, however, syphilis mustbe treated early, before permanent damage occurs. Long-term damage caused bysyphilis (years after exposure) cannot be cured. A person can become reinfectedafter treatment if exposed to syphilis again.

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