Transmission of Borrelia burgdorferi by Blood transfusion?

While babesia has been transferred via bloodtransfusion in several cases, there has not been any verified case of borreliosis transferred via blood transfusion, but there is a potential risk as the spirochete may remain viable and infectious during the normal bank blood storage period.

Survival of Borrelia burgdorferi in blood products.
Badon SJ, Fister RD, Cable RG.
Transfusion 1989 Sep; 29(7): 581-3 PMID: 2773025
The incidence of Lyme disease is rapidly increasing in the United States. To assess the potential of transmission of the disease through blood transfusion, we studied the survival of Borrelia burgdorferi in blood products under blood bank storage conditions. Two units of whole blood, separated into red cells (RBCs), fresh-frozen plasma (FFP), and platelet concentrates (PCs), were inoculated with B. burgdorferi (strain B31) in concentrations of approximately 3000 organisms per mL of RBCs and FFP and 200 organisms per mL of PCs. Products were then stored under blood banking conditions and sampled at several storage times. The viability of the spirochete in blood components was determined by darkfield microscopic examination of cultures in modified Kelly's medium. The organism was shown to survive in RBCs (4 degrees C) and FFP (below -18 degrees C) for 45 days and in PCs (20-24 degrees C) for 6 days. The results of this study do not exclude the possibility of transmission of Lyme disease through blood transfusion.   

Prevalence of Erythema migrans Borreliosis in blood donors.
Schmidt R, Gollmer E, Zunser R, Kruger J, Ackermann R.
Infusionstherapie 1989 Dec; 16(6): 248-51 PMID: 2625363
European Erythema migrans Borreliosis and North American Lyme disease are closely related to syphilis. This implicates a potential risk of infection for blood recipients. Eighty-six of 3,157 blood donors tested showed IgG-antibodies against Borrelia Burgdorferi. From among 47 persons of this group who could be examined, clinical signs of diseased skin, joints or nervous system, not diagnosed before, were found or could be suspected in 13 cases. Since intrauterine transmission of Borrelia infection has been described, the inevitable question of whether this disease can also be transmitted as a result of blood transfusion becomes a major concern. As the pathogen can persist even in the presence of serum antibodies, it seems advisable to examine blood donors serologically, whenever Erythema migrans Borreliosis is suspected. Though further research is required to document a transfusion-transmitted Borrelia infection, infected persons should be treated to avoid serious or late manifestations.

Survival of Borrelia burgdorferi in human blood stored under blood banking conditions.
Nadelman RB, Sherer C, Mack L, Pavia CS, Wormser GP.
Transfusion 1990 May; 30(4): 298-301 PMID: 2349627
Hematogenous dissemination of organisms occurs in many spirochetal diseases, including Lyme disease and syphilis. Although syphilis has been transmitted by transfusion, in the vast majority of cases, only fresh blood products were involved, in part because Treponema pallidum survives poorly when refrigerated in citrated blood. Because of the rising incidence of Lyme disease in certain areas, whether its causative agent, Borrelia burgdorferi, could survive under blood banking conditions was studied. Dilutions of stock cultures of two strains of B. burgdorferi were inoculated into samples of citrated red cells (RBCs). Viable spirochetes were recovered from RBCs inoculated with 10(6) organisms per mL, after refrigeration for as long as 6 weeks. It is concluded that B. burgdorferi may survive storage under blood banking conditions and that transfusion-related Lyme disease is theoretically possible.

Borrelia burgdorferi: survival in experimentally infected human blood processed for transfusion.
Johnson SE, Swaminathan B, Moore P, Broome CV, Parvin M.
J Infect Dis 1990 Aug; 162(2): 557-9 PMID: 2373880
The isolation of Borrelia burgdorferi from blood raises the possibility of bloodborne transmission of Lyme borreliosis through transfusions. To assess this possibility, the ability of B. burgdorferi to survive in human blood processed for transfusion was studied. Human blood was inoculated with B. burgdorferi type strain B-31 (ATCC 35210) at 0.2, 20, or 2000 viable cells/ml, processed by conventional blood banking procedures, stored at 4 degrees C, and cultured for B. burgdorferi at 12, 23, 36, and 48 days of storage. After processing, most B. burgdorferi were found in the packed cell fraction. At inoculum levels of 20 or 2000 viable cells/ml, B. burgdorferi survived in processed blood through 48 days of storage at 4 degrees C. B. burgdorferi was isolated from packed cells after 36 days of storage at 4 degrees C even when the initial inoculum level was as low as 0.2 cells/ml. The data demonstrate that B. burgdorferi can survive the blood processing procedures normally applied to transfused blood in the USA. Since hematogenous spread of the spirochete seems to occur early in the illness, primarily in symptomatic patients, the risk of transfusion-associated Lyme disease may be small. However, the possibility of survival of B. burgdorferi under blood banking conditions warrants a heightened awareness of this potential problem.

[Retrospective study of a borreliosis infected blood donor]
Weiland T, Kuhnl P, Darda C, Sibrowski W, Pulz M.  
Beitr Infusionsther 1991; 28: 32-4  PMID: 1725647
Lyme disease is caused by a spirochete, Borrelia burgdorferi, and represents a potential transfusion hazard. Some Borrelia burgdorferi-infected blood donors may not be disqualified by standard donor selection procedures, thus possibly transmitting the disease. In a follow-up of 14 recipients of blood products donated by such a donor, no clinical signs or serologic evidence of a transfusion-transmitted borreliosis could be demonstrated.  

Screening of blood donors and recipients for Borrelia burgdorferi antibodies: no evidence of B. burgdorferi infection transmitted by transfusion.
Bohme M, Schwenecke S, Fuchs E, Wiebecke D, Karch H.
Infusionsther Transfusionsmed 1992 Aug; 19(4): 204-7 PMID: 1422081
In the study presented here, the prevalence of antibodies against Borrelia burgdorferi, the etiologic agent of Lyme borreliosis, was determined in a group of blood donors from the Wurzburg area (Southern Germany). 13 of 472 donors (2.7%) tested were positive by immunoblotting (IB). These 13 donors were examined in more detail by physical examination, anamnesis and determination of inflammation parameters of the blood. All persons were asymptomatic for Lyme borreliosis. One of 5 who remembered a tick bite actually had suffered from an erythema chronicum migrans 5 years ago. Another one had been affected by fever, headaches and pain in the limbs, arthralgia and motoric disorder in both hands 6 months before examination. Analysis of the blood did not provide any evidence of an acute infection. Moreover, each of the 472 serum samples was analyzed by a hemagglutination test (HAT). 26 (5.5%) showed a positive test result. In order to investigate whether a seroconversion of the recipients by transfusion of B. burgdorferi antibody-positive blood had taken place, 9 recipients of blood products originating from the 13 IB-positive donors were serologically reexamined. All samples taken proved to be antibody-negative. Consequently, the transfusion did not produce any seroconversion in the patients thus treated. 

[Prevalence of Borrelia burgdorferi antibodies in Hamburg blood donors]
Weiland T, Kuhnl P, Laufs R, Heesemann J.
Beitr Infusionsther 1992; 30: 92-5 PMID: 1284777
One thousand regular blood donors of the Department of Transfusion Medicine at the University Hospital in Hamburg were screened for antibodies against the Lyme disease spirochete, B. burgdorferi. 7.2% were initially reactive in the enzyme immunoassay, 37.5% of which were confirmed by immunoblot. The seroprevalence of anti-B. burgdorferi antibodies thus is 2.7% in Hamburg blood donors. 25 of 27 positive donors received a physical exam, which did not reveal any symptoms of acute or chronic Lyme disease. 24 of these 25 donors were tested for B. burgdorferi-specific DNA in urine by polymerase chain reaction, which came out negative in all cases. Introduction of B. burgdorferi antibody screening is not regarded an effective means to prevent transfusion-transmitted Lyme disease.  

[Infections with Borrelia burgdorferi in Wurzburg blood donors: antibody prevalence, clinical aspects and pathogen detection in antibody positive donors]
Bohme M, Schembra J, Bocklage H, Schwenecke S, Fuchs E, Karch H, Wiebecke D.
Beitr Infusionsther 1992; 30: 96-9 PMID: 1284778
The prevalence of antibodies against Borrelia burgdorferi, the etiologic agent of Lyme borreliosis, was determined in a group of blood donors from the Wurzburg area (Southern Germany). 26 of 472 donors (5.5%) tested positive in a hemagglutination test. When performing immunoblots only 13 donors (2.7%) gave rise to B. burgdorferi-specific antibodies. 9 of them were examined in more detail by anamnesis, physical examination, determination of inflammation parameters of the blood and polymerase chain reaction (PCR) analysis of urine. All persons were asymptomatic for Lyme borreliosis. One of 4, who remembered a tick bite, actually had suffered from an erythema migrans 5 years ago. Another one had been affected by fever, headaches and pains in the limbs, arthralgia and motoric disorder in both hands 6 months before examination. Analysis of the blood did not provide any evidence of an acute infection. In the urine of 2 donors we detected B. burgdorferi-specific DNA by PCR. No seroconversion due to blood transfusion could be observed, when 9 recipients of blood products provided by the 13 seropositive donors were serologically reexamined. PCR analysis of urine samples of 5 recipients was also negative.  

Transfer of Borrelia burgdorferi s.s. infection via blood transfusion in a murine model.
Gabitzsch ES, Piesman J, Dolan MC, Sykes CM, Zeidner NS.
J Parasitol. 2006 Aug;92(4):869-70. PMID: 16995409
Without antibiotic treatment, the Lyme-disease-causing bacterium, Borrelia burgdorferi can be cultured from the peripheral blood of human patients nearly 6 wk post-tick bite. To determine if Lyme disease spirochetes can be transmitted from a spirochetemic donor mouse to a naive recipient during blood transfusion, blood taken from immunocompetent infected mice was transfused into either immunodeficient (SCID) mice, inbred immunocompetent animals (C3H/HeJ), or outbred mice. Nine of 19 (47.7%) immunodeficient mice, 7 of 15 (46.8%) inbred immunocompetent mice, and 6 of 10 (60.0%) outbred mice became infected with B. burgdorferi after transfusion. Our results indicate that it is possible to acquire B. burgdoferi infection via transfused blood in a mouse model of Lyme borreliosis.