Transfusion-induced Malaria Research Articles

Transfusion-induced Plasmodium falciparum malaria in a beta thalassaemia patient during the prevention of re-establishment phase in Sri Lanka

BackgroundMalaria was eliminated from Sri Lanka in 2012, and since then 50–60 imported malaria cases have been reported yearly. The country has remained malaria-free since, except for a single case of indigenous malaria in 2018. Blood donors are routinely screened for malaria, and transfusion malaria has not been reported in the country since 1966.Case presentationA 17-year-old splenectomized beta thalassaemia patient developed a transfusion-induced Plasmodium falciparum malaria infection following a blood transfusion 18 days earlier. The blood donor was an armed forces personnel who returned from South Sudan following a United Nations peace-keeping mission. The blood recipient’s malaria infection took a complicated clinical course with elevated liver enzymes, lowered blood pressure and a prolonged parasite clearance time of 7 days but he recovered fully after two courses of artemether-lumefantrine interrupted by a course of intravenous artesunate. The prolonged parasite clearance is likely due to lack of splenic clearance of dead or damaged intra-erythrocytic parasites (due to a splenectomy) rather than to the parasite strain being resistant to artemisinin or the partner drug. This is corroborated by the fact that the blood donor’s infection responded to artemether-lumefantrine with parasites being cleared on day 3. The blood donor who had not displayed signs or symptoms of malaria, had been screened for malaria on arrival in Sri Lanka and was negative on both microscopy and RDT. At the point of blood donation a blood smear examined microscopically was also reported negative for malaria, but retrospectively, the preserved smear of the donor’s blood was found to contain P. falciparum parasites at a very low density. The donor when tested after the transfusion-induced case was diagnosed, also tested positive for malaria and was treated.ConclusionsAfter malaria elimination, transfusion-induced malaria from blood donors returning from malaria endemic countries poses a threat to preventing the re-establishment of the disease. Improved surveillance of arrivals in Sri Lanka from malaria endemic countries using more sensitive methods for screening than microscopy may be required to reduce this risk. More stringent criteria for selecting blood donors, and more effective methods of screening donors for malaria than microscopy may also be necessary.

Epidemic situation of malaria in Lishui City from 2013 to 2018

To analyze the epidemic situation and epidemiological characteristics of malaria in Lishui City from 2013 to 2018, so as to provide the evidence for formulating the malaria control strategy. The data pertaining malaria cases in Lishui City from 2013 to 2018 were captured from National Notifiable Communicable Disease Reporting System and the Information System for Parasitic Diseases Control and Prevention, and the epidemiological features of malaria cases were analyzed. A total of 119 malaria cases were reported in Lishui City from 2013 to 2018, including 101 cases with falciparum malaria (84.87%), 6 cases with vivax malaria (5.04%), 8 cases with ovale malaria (6.72%), and 4 cases with mixed infection (3.36%). Among the 119 cases, there were one local case with blood transfusion-induced malaria and 118 cases with over- seas imported malaria. There were 98.32% of the imported malaria cases acquiring infection in African countries, and most cases were reported in Qingtian County (60.50%) and Liandu District (22.69%). In addition, 86.55% of the malaria cases were detected in individuals at ages of 20 to 50 years, and most cases were found in oversea workers (52.94%) and businessmen (38.65%). Most of the malaria cases in Lishui City are imported from Africa, and the monitoring and health education pertaining to malaria control knowledge requires to be intensified among high-risk populations.

Observation of Blood Donor-Recipient Malaria Parasitaemia Patterns in a Malaria Endemic Region.

Background Asymptomatic malaria parasitaemia has been documented in donor blood in West Africa. However, donated blood is not routinely screened for malaria parasites (MPs). The present study therefore aimed to document the frequency of blood transfusion-induced donor-recipient malaria parasitaemia patterns, in children receiving blood transfusion in a tertiary health-centre. Methodology A cross-sectional, observational study involving 140 children receiving blood transfusion was carried out. Blood donor units and patients' blood samples were obtained, for the determination of malaria parasites (MPs). Giemsa staining technique was used to determine the presence of malaria parasitaemia. Results Malaria parasites were detected in 7% of donor blood and in 8.3% of the recipients' pretransfusion blood. The incidence of posttransfusion MPs was 3%, but none of these were consistent with blood transfusion-induced malaria, as no child with posttransfusion parasitaemia was transfused with parasitized donor blood. Majority of the blood transfusions (89.4%) had no MPs in either donors or recipients, while 6.8% had MPs in both donors and recipients, with the remaining 3.8% showing MPs in recipients alone. Conclusion In conclusion, the incidence of posttransfusion malaria parasitaemia appears low under the prevailing circumstances.

Eradication of Transfusion-Induced Malaria by <i>In vitro</i> Processing

OBJECTIVE: To determine the lethal dose of chloroquine to be added to donors’ blood in vitro for eradication of transfusion-induced malaria and to study the unfavorable effects of this dose on the constituents of the stored blood. METHODS: A total of 4484 blood donors, recruited for this study, were screened for malaria parasites microscopically using Giemsa’ staining technique. Only 30 blood samples (200ml of blood each) satisfied the inclusion criteria of the study. Each of these blood samples was subdivided equally into four sub-samples to obtain 120 sub-samples. Three different concentrations of chloroquine were added to 90 specimens (30 samples represent each dose) while 30 specimens (control) were left without the drug. Blood specimens were then tested by parasitic, hematological and biochemical techniques on the day of collection and after 24 and 48 hours storage in blood bank refrigerator. RESULTS: The numbers of malaria parasites killed were proportional to chloroquine doses added to donors’ blood. No parasites were killed among the control donors’ blood samples. The determined lethal dose of chloroquine was safe to all constituents of the stored blood. CONCLUSION: For eradication of transfusion induced malaria by in vitro processing of donors blood, chloroquine is effective and safe drug. We recommend application of the optimal dose of chloroquine (626.1g/L) to the components of the blood bags prior to phlebotomy. Keywords : chloroquine, malignant tertian malaria, prothrombin Sudan Journal of Medical Science Vol. 3 (4) 2008: pp. 291-300

IN VITRO PROCESSING OF DONOR BLOOD WITH SULFADOXINE-PYRIMETHAMINE FOR ERADICATION OF TRANSFUSION-INDUCED MALARIA

Transfusion-induced malaria is a problem because of the large number of parasites infused and the weakness of transfused patients. Screening of blood donors or treatment of transfused patients or prospective donors does not eliminate this hazard. It is essential to kill the parasite in vitro in the blood of donors before transfusion. A total of 4,484 blood donors were screened for malaria parasite microscopically using the Giemsa staining technique. Only 30 matched the inclusion criteria of this study. Blood samples were divided into four equal samples. Three concentrations of sulfadoxine-pyremthamine (SP) were added to 90 specimens, and none was added to 30 specimens (controls). Blood specimens were then tested by parasitic, biochemical, and hematologic techniques on the day of collection and after 24 and 48 hours of storage in a blood bank refrigerator. The reduction of malaria parasites was proportional to the concentrations of SP and to the storage period. Blood samples without SP had steady number of the parasites. The lethal dose of SP (the dose that killed 99% of the malaria parasites within 24 hours) was 179.65 mug/L and was highly effective within the 24-hour storage period. This dose did not affect constituents of the stored blood. Thus, for eradication of transfusion-induced malaria by in vitro processing of donors blood, SP is a safe and effective drug. It is recommended that optimal doses of SP be added to donated blood prior to phlebotomy.

Screening blood donors for malaria parasite in Sudan

Abstract Background: In countries where malaria is endemic, its transmission is a hazard of blood transfusion and could lead to serious if not fatal complications. To assess the likely importance of transfusion induced malaria in Sudan; a descriptive cross sectional facility based study was carried out. Material and Methods: A total number of 1564 blood donors were screened for malaria parasite by thick and thin blood film using Geimsa’ staining technique. All the 397 transfused patients who received the donors’ blood during the study period were investigated for malaria before transfusion by the same technique, followed up for four days after transfusion and reinvestigated, if any signs of malaria were present. Results: Results showed that the prevalence of infected donors was 6.5%, the majority of them were between 20 and 40 years old; the required age for donation. The recognized species were predominantly (98.1%) Plasmodium falciparum and secondly Plasmodium vivax (1.9%). Mainly ring (50.5%) and trophozoite (40.2%) stages were detected, and most of the positive blood films (96.9%) showed densities less than 1000 parasites/µl. Post transfusion malaria (PTM) was observed in 2.9% of the single transfused and in 4.9% of the multiple transfused patients. Conclusion: It was concluded that the infectivity of asymptomatic donors is considerable. Moreover, the exclusion of this percentage minimizes the risk of transfusion-induced malaria and does not affect donation flow. [Ethiop.J.Health Dev. 2004;18(2)70-74]

Malaria Screening of Blood Donors in Saudi Arabia

Transfusion-associated malaria is a potentially serious complication that continues to pose risks in blood bank settings. There is a need for effective malaria screening of blood donations to improve on the current exclusion policies of potentially infected carriers on the basis of clinical and travel history. We evaluated the potential usefulness of ELISA screening for malaria antibody and P. falciparum antigen among Saudi blood donors. A total of 1756 donors were studied, 1100 from the malaria endemic Southern Region and 656 donors from the known malaria-free Riyadh area. The overall antibody prevalence for the antibody was 7.6%, in comparison to only 0.17% for the antigen. In the endemic region, the antibody positivity rate of 9.1% was almost double the rate in the non-endemic area (4.8%). There was no difference in the antigen prevalence rates; 0.18% in endemic and 0.15% in nonendemic areas. In malaria endemic countries like Saudi Arabia, excluding antibody-positive donations would result in too much wastage of blood units. However, antigen malaria testing appears to offer a potential utility, as only few donations would be rejected.

Neonatal Exchange Transfusions Complicated by Transfusion-Induced Malaria

Two neonates who became infected with Plasmodium vivax subsequent to exchange transfusion are described. This complication of neonatal exchange transfusion is unusual in that only two other similar cases have been reported to the Centers for Disease Control. Although malaria is an unusual complication, it should be kept in mind when considering the differential diagnoses of fever following neonatal exchange transfusion. The risk of transfusion-induced malaria may be increasing due to the influx of immigrants from areas endemic for malaria. Careful blood donor selection and blood donor education may minimize this risk.

Indirect ELISA test for malaria in blood donors

To determine the potential risk of transfusion malaria at the Hospital Militar Central in Bogota, Colombia, sera from 3114 blood donors were tested for malaria antibodies by the indirect ELISA technique. Positive results were found in 8·6 per thousand of the serum samples using P. falciparum antigen containing more than 60% mature forms as substrate. Three cases of transfusion-induced malaria were confirmed during the study. The first patient developed a P. vivax infection one week after the administration of one unit of infected blood. The other two patients received a red blood cell concentrate and a platelet preparation, respectively, derived from a single donor and developed a P. falciparum infection eight days after transfusion. The application of the ELISA technique would be of use in attempts to control transfusion-induced malaria.

Transfusion malaria in the United States, 1972-1981.

Twenty-six cases of transfusion-induced malaria were reported in the United States from 1972 through 1981. In nine patients malaria was due to Plasmodium malariae; eight, P. falciparum; eight, P. vivax; and one, P. ovale. Four patients died. The estimated rate of transfusion malaria for this period was 0.25 cases per million donor units collected. Of the 18 cases in which a specific infective blood donor could be identified, at least nine of the donors should have been rejected for blood donation because of recent residence or travel to a malarious area. Among 17 patients for whom the national origin of the implicated blood donor was reported, 12 were born in malarious countries. We propose minor changes in donor procedures and standards, including stricter criteria for donors born in malarious countries. Potential donors should be deferred for 3 years after an unexplained febrile illness occurring 1 year after exposure to malaria.

Detección de anticuerpos antiplasmodium por ELISA en donantes de sangre

In order to determine the risk of transfusion-induced malaria in the Blood Bank of the Hospital Militar Central in Bogotá, 3114 sera from blood donnors were collected during a period of nine months. These sera were analysed by the indirect E.L.I.S.A. technique using P. falciparum antigen containing more than 60% of schizonts. Malaria antibodies were detected in 27 sera, representing 8.6 per thousand of total samples. Three cases of malaria following blood transfusion were recorded during the study.

Malaria Complicating Neoplastic Disease

Two patients with neoplastic disease had transfusion-induced malaria. In a patient with acute myelogenous leukemia infected with Plasmodium vivax, neither his underlying disease nor intensive cytotoxic chemotherapy appeared to ameliorate or worsen the clinical course of his infection. In a splenectomized patient with metastatic carcinoma of the colon, P malariae infection was associated with a fulminant course simulating cerebral malaria. Despite delay in diagnosis, both patients responded dramatically to antimalarial chemotherapy and both developed appreciable antibody responses.

Transfusion-Induced Malaria

To the Editor .—In the paper on transfusion malaria 1 the authors report that a course of primaquine phosphate was given in accordance with my recommendations. 2 I believe that an important point has been overlooked. When malaria is acquired by inoculation of infected blood, in contrast with inoculation by mosquito, no exoerythrocyte hepatic infection is established. Therefore, relapses do not occur and primaquine, an occasionally toxic drug, is unnecessary.

Transfusion-Induced Malaria-Reply

To the Editor .—We wish to thank Drs. Frothingham and Katz for emphasizing that transfusion-induced malaria is different from the naturally acquired form. It would appear that the addition of primaquine phosphate was unnecessary in our patient. As Dr. Katz points out, infection with Plasmodium falciparum may be resistant to conventional therapy. However, all forms of malaria may be spread by infected blood.

Transfusion-Induced Malaria

To the Editor .—The article by Seeler et al in the January issue of theJournal(125:132, 1973) describes a case of transfusion malaria, due to Plasmodium vivax , treated successfully with chloroquine phosphate. The authors state that they subsequently treated the patient also with primaquine phosphate. They cite as their authority for this form of treatment the 14th (1968) edition of Pediatrics by Barnett. Since primaquine is effective only against the exoerythrocytic cycle of malaria, and since transfusion malaria, in contrast to that acquired through a mosquito bite, lacks the exoerythrocytic cycle, administration of this drug to the infant described by the authors was unnecessary. In view of the fact that primaquine has been associated with toxic side effects, the authors' error of commission ought not to be perpetuated. I am concerned that their article appearing in your widely read journal may do just that. It is true that the

Transfusion-induced malaria. Plasmodium vivax in a 5-month-old child.

A 5-month-old infant developed malaria 16 days after cardiac surgery. After transfusion, one must consider the possibility of transfusion-induced malaria in any patient with the triad of fever, hepatosplenomegaly, and hemolysis.

Transfusion-Induced Falciparum Malaria

<h3>To the Editor.—</h3> The increased incidence of malaria in the United States is largely attributable to returning war veterans from South Vietnam. Transfusion-induced malaria has also increased. Transfusion-induced falciparum malaria observed in an anephric patient receiving long-term hemodialysis illustrates the possibility of transmission of falciparum malaria from an asymptomatic donor, with no history of malaria, who had last been in a malarious area one year prior to blood donation. <h3>Report of a Case.—</h3> A 34-year-old white man in renal failure had been receiving hemodialysis for five years. Bilateral nephrectomy had been performed three years previously for control of hypertension. On Nov 5, 1970, six days after his last monthly transfusion, fever, chills, malaise, and headache began. Another eight days later, the 48-hour periodicity of his temperature elevations was noted. A peripheral blood smear revealed ring forms of<i>Plasmodium falciparum</i>in less than 1% of the red blood cells (RBC) (Fig