Donor‐derived multiorgan transmission of mixed P. malariae and P. ovale infection: Impact of globalization on post‐transplant infections

Abstract

A 57-year-old man was admitted with fever and thrombocytopenia 1 month after renal transplantation. He had never received a blood transfusion or travelled outside Spain. A peripheral blood smear revealed Plasmodium malariae and P. ovale parasites, diagnosis confirmed later by malaria PCR. The donor, from Equatorial Guinea, had negative thick and thin blood smears and rapid malaria antigen test prior to organ donation. Peripheral blood malaria PCR was not performed during donor screening. The second renal recipient and the liver recipient were evaluated and were found to be asymptomatic. Thick and thin films and rapid malaria diagnostic tests were negative for both patients and blood for malaria PCR was sent to the referral laboratory. The index patient was treated with oral chloroquine diphosphate, with a favorable outcome and was considered cured. Malaria PCR was negative for the other renal recipient and positive for P. malariae and P. ovale curtisi for the liver transplant patient. Both were treated with oral chloroquine and the liver recipient also completed treatment with primaquine phosphate. This reported case of multiorgan transmission of mixed malaria infection highlights the importance of PCR-based tests for Plasmodium in the screening of donors from endemic areas.

Unexpected encounter of the parasitic kind

“…For these reasons, reports of malaria infection following transplantation are not surprising. Indeed, Martín-Dávila et al[96] recently reported patients infected by P. malariae and P. ovale after liver and kidney transplantations. Parasite transmission can also occur after BM transplantation as described in a recent case even when the donor was not classified at risk[97].…”

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

“…Even with the use of the most sensitive diagnostic test on blood, liver transplantation has been associated with the transmission of P. vivax due to the persistence of hepatic hypnozoites, which is also possible for P. ovale [112,113]. Several cases of multi-organ transmission of malaria from a single donor have been described [107,114,115].…”

“…Post-transplant malaria presents with high fever and chills that do not respond to empirical antibiotic therapy [107,114,115,[118][119][120][121]; thrombocytopenia and anemia are commonly observed as in the case of vector-borne malaria [114,115,[118][119][120][121]. Mental impairment, coma, or acute renal failure may be observed as complications of P. falciparum malaria when the diagnosis is delayed [115,118,119].…”

“…In all the reported cases of post-transplant malaria, the correct diagnosis was always achieved by conventional thick and thin smears of peripheral blood [8,107,[112][113][114][115][118][119][120][121]. Few cases of mixed infections caused by P. falciparum and P. vivax as well as by P. malariae and P. ovale were reported in the literature [114,121]. To the best of our knowledge, a very sensitive quantitative PCR for malaria has been used only in a single case of an allogenic haematopoietic stem cell transplant patient; it showed a long-term persistence of a positive PCR result (> 30 days) after therapy-induced resolution of symptoms and parasite disappearance detected by microscopy [109].…”

Molecular monitoring of the diversity of human pathogenic malaria species in blood donations on Bioko Island, Equatorial Guinea

“…The rate of transfusion-transmitted malaria (TTM) in malaria endemic sub-Saharan regions is estimated between 14 and 28% [22]. Several reports describe that P. falciparum [22], P. vivax [23], P. malariae [24], P. knowlesi [25] and P. ovale [26] can be transmitted either through blood donations or solid organ transplantations.…”