Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia

A case report

Elspeth Bird, Uma Parameswaran, Timothy Williams, Tienmeng Khoo, Matthew Grigg, Ammar Aziz, Jutta Marfurt, Tsin Yeo, Sarah Auburn, Nicholas Anstey, Bridget Barber

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Abstract

Background: Transfusion-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 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 the P. knowlesi bifunctional dihydrofolate reductase-thymidylate synthase gene (pkdhfr) revealed that the recipient and donor shared the same haplotype.

Conclusions:This 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.
Original languageEnglish
Article number357
Pages (from-to)1-6
Number of pages6
JournalMalaria Journal
Volume15
Issue number1
DOIs
Publication statusPublished - 2016

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Plasmodium knowlesi
Plasmodium malariae
beta-Thalassemia
Malaysia
Malaria
Blood Transfusion
Plasmodium ovale
Parasites
Tissue Donors
Plasmodium vivax
Plasmodium falciparum
Acidosis
Blood Donors
Base Pairing
Haplotypes
Fever
Incidence
Infection

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@article{993db86e8d5f4d2ea3e0f043a7a2b175,
title = "Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia: A case report",
abstract = "Background: Transfusion-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 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 the P. knowlesi bifunctional dihydrofolate reductase-thymidylate synthase gene (pkdhfr) revealed that the recipient and donor shared the same haplotype.Conclusions:This 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.",
author = "Elspeth Bird and Uma Parameswaran and Timothy Williams and Tienmeng Khoo and Matthew Grigg and Ammar Aziz and Jutta Marfurt and Tsin Yeo and Sarah Auburn and Nicholas Anstey and Bridget Barber",
note = "National Health Medical Research Council of Australia (Grant Number 10451516; Fellowships to NMA, TWY and BEB; and scholarship to MJG).",
year = "2016",
doi = "10.1186/s12936-016-1398-z",
language = "English",
volume = "15",
pages = "1--6",
journal = "Malaria Journal",
issn = "1475-2875",
publisher = "BioMed Central",
number = "1",

}

Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia : A case report. / Bird, Elspeth; Parameswaran, Uma; Williams, Timothy; Khoo, Tienmeng; Grigg, Matthew; Aziz, Ammar; Marfurt, Jutta; Yeo, Tsin; Auburn, Sarah; Anstey, Nicholas; Barber, Bridget.

In: Malaria Journal, Vol. 15, No. 1, 357, 2016, p. 1-6.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia

T2 - A case report

AU - Bird, Elspeth

AU - Parameswaran, Uma

AU - Williams, Timothy

AU - Khoo, Tienmeng

AU - Grigg, Matthew

AU - Aziz, Ammar

AU - Marfurt, Jutta

AU - Yeo, Tsin

AU - Auburn, Sarah

AU - Anstey, Nicholas

AU - Barber, Bridget

N1 - National Health Medical Research Council of Australia (Grant Number 10451516; Fellowships to NMA, TWY and BEB; and scholarship to MJG).

PY - 2016

Y1 - 2016

N2 - Background: Transfusion-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 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 the P. knowlesi bifunctional dihydrofolate reductase-thymidylate synthase gene (pkdhfr) revealed that the recipient and donor shared the same haplotype.Conclusions:This 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.

AB - Background: Transfusion-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 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 the P. knowlesi bifunctional dihydrofolate reductase-thymidylate synthase gene (pkdhfr) revealed that the recipient and donor shared the same haplotype.Conclusions:This 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.

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U2 - 10.1186/s12936-016-1398-z

DO - 10.1186/s12936-016-1398-z

M3 - Article

VL - 15

SP - 1

EP - 6

JO - Malaria Journal

JF - Malaria Journal

SN - 1475-2875

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