Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia: a case report

Malaria Journal

Case Report

Uma Parameswaran¹  Elspeth M. Bird¹  Matthew J. Grigg²  Bridget E. Barber²  Nicholas M. Anstey²  Tsin W. Yeo³  Timothy William⁴  Tien Meng Khoo⁵  Ammar Aziz⁶  Sarah Auburn⁶  Jutta Marfurt⁶ 

[1] Infectious Diseases Society Sabah Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia;Infectious Diseases Society Sabah Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia;Menzies School of Health Research and Charles Darwin University, PO Box 41096, 0810, Casuarina, NT, Australia;Infectious Diseases Society Sabah Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia;Menzies School of Health Research and Charles Darwin University, PO Box 41096, 0810, Casuarina, NT, Australia;Lee Kong Chian School of Medicine, Nanyang Technological University, 639798, Singapore, Singapore;Infectious Diseases Society Sabah Menzies School of Health Research Clinical Research Unit, 88586, Kota Kinabalu, Sabah, Malaysia;Queen Elizabeth Hospital Clinical Research Centre, 88586, Kota Kinabalu, Malaysia;Jesselton Medical Centre, 88300, Kota Kinabalu, Sabah, Malaysia;Intensive Care Unit, Queen Elizabeth Hospital, 88586, Kota Kinabalu, Sabah, Malaysia;Menzies School of Health Research and Charles Darwin University, PO Box 41096, 0810, Casuarina, NT, Australia;

关键词: Plasmodium knowlesi;    Severe malaria;    Transfusion-transmitted malaria;    Malaria transmission;    Beta thalassemia;    Splenectomy;    PCR;    Sabah;    Borneo;   

DOI  :  10.1186/s12936-016-1398-z

 received in 2016-05-11, accepted in 2016-06-16,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundTransfusion-transmitted malaria (TTM) is a well-recognized risk of receiving blood transfusions, and has occurred with Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae. The simian parasite Plasmodium knowlesi is also known to be transmissible through inoculation of infected blood, and this species is now the most common cause of malaria in Malaysia with a high rate of severity and fatal cases reported. No confirmed case of accidental transfusion-transmitted P. knowlesi has yet been reported.Case presentationA 23-year old splenectomized patient with beta thalassaemia major presented with fever 11 days after receiving a blood transfusion from a pre-symptomatic donor who presented with knowlesi malaria 12 days following blood donation. The infection resulted in severe disease in the recipient, with a parasite count of 84,000/µL and associated metabolic acidosis and multi-organ failure. She was treated with intravenous artesunate and made a good recovery. Sequencing of a highly diverse 649-base pair fragment of the P. knowlesi bifunctional dihydrofolate reductase-thymidylate synthase gene (pkdhfr) revealed that the recipient and donor shared the same haplotype.ConclusionsThis case demonstrates that acquisition of P. knowlesi from blood transfusion can occur, and that clinical consequences can be severe. Furthermore, this case raises the possibility that thalassaemic patients, particularly those who are splenectomized, may represent a high-risk group for TTM and severe malaria. With rising P. knowlesi incidence, further studies in Sabah are required to determine the risk of TTM in order to guide screening strategies for blood transfusion services.

【 授权许可】

CC BY   
© The Author(s) 2016