Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia: a case report. (December 2016) - Bird, Elspeth
Abstract Background Transfusion-transmitted malaria (TTM) is a well-recognized risk of receiving blood transfusions, and has occurred withPlasmodium falciparum, Plasmodium vivax, Plasmodium ovale, andPlasmodium malariae. The simian parasitePlasmodium 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-transmittedP. knowlesi has yet been reported. Case presentation A 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 theP. knowlesi bifunctional dihydrofolate reductase-thymidylate synthase gene (pkdhfr ) revealed that the recipient and donor shared the same haplotype. Conclusions This case demonstrates that acquisition ofP. 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 risingP. knowlesi incidence, further studies in Sabah are required to determine the risk of TTM in order to guide screening strategies for blood transfusion services.