ABSTRACT
@#Blood safety is a major global issue. Transfusion transmitted parasitic infections (TTPI) like malaria are rare and possibly under-reported, a situation which could be attributed to lack of awareness of the mosquito-borne transmission of infection. Such infections are still considered potential health hazards, as they can pose a significant threat especially in immunocompromised patients, where they have proven to be fatal. Prevention of the transmission depends solely on the donor’s questionnaire which addresses previous or current infection with aetiologic agents. Donor deferral is effective however clear guidelines are needed. This case report features the transfusion-transmitted of Plasmodium Falciparum in a 15-year-old splenectomised patient with underlying beta thalassaemia major.
ABSTRACT
Malaria in Brazil is endemic in the Amazon region, but autochthonous cases with low parasitaemia occur in the Atlantic Forest area of the country. According to Brazilian legislation no test is mandatory for blood donors from non-endemic areas. However if they have traveled to malaria transmission regions they are deferred for six months before they can donate. This report describes a transfusion-transmitted malaria case in Sao Paulo, Brazil, where one recipient received infected blood and developed the disease. He lived in Sao Paulo and had no previous transfusion or trips to endemic areas, including those of low endemicity, such as Atlantic Forest. Thick blood smears confirmed Plasmodiummalariae. All donors lived in Sao Paulo and one of them (Donor 045-0) showed positive hemoscopy and PCR. This asymptomatic donor had traveled to Juquia, in the Atlantic Forest area of S ao Paulo State, where sporadic cases of autochthonous malaria are described. DNA assay revealed P. malariae in the donor's (Donor 045-0) blood. Serum archives of the recipient and of all blood donors were analyzed by ELISA using both P. vivax and P. falciparum antigens, and IFAT with P. malariae. Donor 045-0's serum was P. malariae IFAT positive and the P. vivax ELISA was reactive. In addition, two out of 44 donors' archive sera were also P. vivax ELISA reactive. All sera were P. falciparum ELISA negative. This case suggests the need of reviewing donor selection criteria and deferral strategies to prevent possible cases of transfusion-transmitted malaria.
No Brasil a malária é endêmica na Amazônia, porém casos autóctones com baixas parasitemias ocorrem na área costeira de Mata Atlântica. De acordo com a legislação brasileira, não são obrigatórios testes para detecção de malária em doadores de sangue de áreas não-endêmicas; entretanto são excluídos por seis meses aqueles com relato de deslocamento para áreas de transmissão. Este trabalho descreve um caso de malária transfusional ocorrido em São Paulo, Brasil, em que um paciente recebeu sangue infectado, desenvolvendo a doença. Ele residia em São Paulo e não apresentava histórico de transfusão anterior ou deslocamentos para áreas endêmicas, incluindo as de baixa endemicidade, como a Mata Atlântica. A gota espessa revelou Plasmodium malariae. Os doadores eram residentes em São Paulo e um deles (045-0) apresentou hemoscopia e PCR positivos. Este era assintomático com PCR positiva para P. malariae e viagem para Juquiá, Mata Atlântica de São Paulo, onde são descritos casos esporádicos de malária autóctone. Amostras de soro do receptor e de todos os doadores foram ensaiadas por ELISA com antígenos de P. vivax e P. falciparum e RIFI com P. malariae. O doador 045-0 apresentou RIFI positiva para P. malariae. ELISA-P. vivax foi reagente no doador infectado (045-0) e em dois dos 44 doadores. Todos os soros foram negativos com antígeno de P. falciparum. Este caso aponta a necessidade de revisão dos critérios de triagem clínico-epidemiológica para evitar casos transfusionais e também adequar as estratégias de exclusão de doadores de sangue.
Subject(s)
Humans , Antibodies, Protozoan/blood , Antigens, Protozoan/immunology , Asymptomatic Infections , Blood Transfusion/adverse effects , Malaria/transmission , Plasmodium malariae/immunology , Malaria/diagnosisABSTRACT
BACKGROUND: As the number of malaria patients has increased in Korea, the number of blood donors who are diagnosed as malaria after donation has also increased. And during 1997~2001, ten cases of transfusion-transmitted malaria were reported. We investigated the transfusion safety of blood that was donated by malaria patients before diagnosis. METHODS: For a total of 2,552 malaria patients diagnosed in 2001, blood donation history of past one year before diagnosis was inquired at the beginning of 2002. Then we inquired informations about recipients of the hospitals through the regional Red Cross blood centers. we also inquired development of malaria after transfusion for the recipients in the August of 2002. Malaria antibody test results of donated blood were also analyzed to determine the status of immunity of donors in Seoul, Gyeonggi and Gangwon area. RESULTS: Among 2,552 malaria patients, 162 (6.3%) patients had donated within one year before diagnosis and they were all man. Their blood was processed into 292 units of blood components and supplied to 90 hospitals, where it was transfused 286 patients. Among these 286 patients, no one was diagnosed as malaria until time of database retrieving. Among 162 malaria patient, enzyme immunoassay malaria antibody test results of 107 (66.0%) patients were available, and all were negative. CONCLUSION: No one has developed malaria among the recipients transfused with blood that was donated by malaria patients before diagnosis. Therefore, the infectivity of blood donated before malaria diagnosis is thought to be very low. As antibody to malaria was not produced in some of malaria patients before diagnosis, this finding could be useful for the study of immunology of malaria infection.
Subject(s)
Humans , Allergy and Immunology , Blood Donors , Diagnosis , Immunoenzyme Techniques , Korea , Malaria , Red Cross , Seoul , Tissue DonorsABSTRACT
Since the reemergence of tertian malaria in Korea in 1993, we have confirmed 10 cases of Plasmodium vivax malaria associated with blood transfusion from 1997 to 2001. Age of patients ranged from 4 months to 68 years; three cases were younger than 1 year old. Because 2 of 10 patients received different components of the same donor, 9 presumably infected donors were identified for the 10 cases. Four of them were identified by polymerase chain reaction, 2 by indirect fluorescent antibody test, and 1 donor was identified by peripheral blood film examination. Geographically the cases were distributed over the whole Nation; 3 cases in Seoul, 2 in Kyunggi and Ulsan, and 1 case each in Pusan, KyungNam and Taegu. The infective components were 1 unit of whole blood, 5 units of packed red cells and 4 units of packed platelets. The incubation periods ranged from 9 days to 78 days(mean : 30.5 days, median : 21.5 days). The incidence rate of transfusion-transmitted malaria From 1997 to 2001 calculated as number of cases/number of units of whole blood and packed red cells transfused during each year ranged from 0 to 2.85 cases per million units transfused. Enforced predonation counseling might have prevented some of the above cases. Although test for malaria antibody has been implemented for donor screening this method does not reflect the present infective status of donor. Therefore careful screening of donors according to the exclusion guidelines of the Korean Red Cross remains as the best way to prevent transfusion-transmitted malaria.
Subject(s)
Humans , Blood Transfusion , Counseling , Donor Selection , Incidence , Korea , Malaria , Malaria, Vivax , Mass Screening , Plasmodium vivax , Polymerase Chain Reaction , Red Cross , Seoul , Tissue DonorsABSTRACT
BACKGROUND: After the resurgence of endemic malaria case in 1993, the number of malaria cases is increasing in succeeding years and most of patients were soldiers who served in the northern parts of Kyeonggi-do and Kangwon-do. Because group donations of blood from soldiers are frequent in these area, it is possible that donated blood from these area cause malaria. So we examined blood donation history of malaria patients to know their donation behavior. METHODS: The subject was 1,671 malaria patients who were diagnosed in 1997 and referred to blood transfusion research institute and their past donation history, time and frequency of donation were examined. The database consisted of malaria patients and blood donors who are known to be related with transfusion-transmitted malaria has been retrieved at each red cross blood center for every blood donors. The results were analyzed from January to December, 1998. RESULTS: About 60% (1,017) of 1,691 malaria patients in 1997 had donated their blood before diagnosis. The number of one time donation was 268; two time 289; more than three time was 460. Two hundred thirty six donors were checked by malaria registry file. In 236 donors, 92 cases were diagnosed with malaria, 96 cases were suspected to have malaria, 48 cases were namesakes. Conclusion: Because some malaria patients donate their blood after their diagnosis, it would be necessary to operate 'the computerized retrieving programme'to detect their donation after the diagnosis. Also, an education for malaria patients for their risk of transmitting malaria and strict history taking from donors for malaria will be required.