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




Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia: a case report - Download this document for free, or read online. Document in PDF available to download.

Malaria Journal

, 15:357

First Online: 12 July 2016Received: 11 May 2016Accepted: 16 June 2016DOI: 10.1186-s12936-016-1398-z

Cite this article as: Bird, E.M., Parameswaran, U., William, T. et al. Malar J 2016 15: 357. doi:10.1186-s12936-016-1398-z

Abstract

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.

KeywordsPlasmodium knowlesi Severe malaria Transfusion-transmitted malaria Malaria transmission Beta thalassemia Splenectomy PCR Sabah Borneo AbbreviationspkdhfrP. knowlesi bifunctional dihydrofolate reductase-thymidylate synthase gene

LAMPloop-mediated isothermal amplification

TTMtransfusion transmitted malaria

PCRpolymerase chain reaction

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Author: Elspeth M. Bird - Uma Parameswaran - Timothy William - Tien Meng Khoo - Matthew J. Grigg - Ammar Aziz - Jutta Marfurt -

Source: https://link.springer.com/







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