Abstract
Transfusion-transmitted malaria (TTM) is a rare occurrence with serious consequences for the recipient. In non-endemic areas, the incidence of transmission of malaria by transfusion is very low. We report a clinical case of transfusion-transmitted malaria due to Plasmodium malariae, which happened in a patient with acute hemorrhagic gastropathy. Case presentation: In April 2019, a 70-year-old Italian man with recurrent spiking fever for four days was diagnosed with a P. malariae infection, as confirmed using microscopy and real-time PCR. The patient had never been abroad, but about two months before, he had received a red blood cell transfusion for anemia. Regarding the donor, we revealed that they were a missionary priest who often went to tropical regions. Plasmodium spp. PCR was also used on donor blood to confirm the causal link. Discussion and Conclusions: The donations of asymptomatic blood donors who are predominantly “semi-immune” with very low parasitic loads are an issue. The main problem is related to transfusion-transmitted malaria. Our case suggests that P. malariae infections in semi-immune asymptomatic donors are a threat to transfusion safety. Currently, microscopy is considered the gold standard for the diagnosis of malaria but has limited sensitivity to detect low levels of parasitemia. Screening using serological tests and molecular tests, combined with the donor’s questionnaire, should be used to reduce the cases of TTM.
Highlights
Introduction published maps and institutional affilMalaria is an infectious disease that is caused by intracellular protozoan parasites of the genus Plasmodium spp.; it is responsible for an acute febrile illness with varying severities depending on the species involved and on the subject’s immune status, and on the process of invasion and multiplication of the parasite in human red blood cells (RBCs) during their complex life cycle
We present a case of malaria that was caused by P. malariae associated with transfusion in a patient after having acute hemorrhagic erosive gastropathy
Transfusion-transmitted malaria (TTM) is an accidental Plasmodium spp. infection that is caused by a whole blood or blood component transfusion from a malaria-infected donor to a recipient
Summary
In April 2019, a 70-year-old male patient of Italian nationality who had never been abroad was observed by the Oncohematology and TMO Unit of the Maddalena Clinic for about two months after having a recurrent spiking fever for four days. We learned that he was a missionary priest who had traveled to endemic regions; this was more than 10 years ago. He had been subjected to the mandatory donation tests according to the “Provisions relating to the quality and safety requirements of blood and blood components,”. Based on the donor’s epidemiological history, the patient’s clinical history, and the clinical–laboratory data, blood samples for the antigenic, microscopic, and molecular identification of Plasmodium spp. were sent to the Unit of Microbiology and Virology of the Paolo Giaccone Hospital in Palermo. After infectious counseling with the Infectious and Tropical Diseases Unit of the Paolo Giaccone Hospital, therapy began with piperaquine tetraphosphate + dihydroartemisinin (Eurartesim) 320/40, which was followed by an improvement of health with a resolution of fever, recovery of liver and kidney function, and a return of the blood count within normal parameters
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