The monitoring of hematopoietic stem cell transplant donors and recipients from endemic areas for malaria

Abstract

SUMMARYMalaria is an unusual complication after hematopoietic stem cell transplantation in non-endemic countries. However, transplant candidates, recipients and donors living in endemic regions frequently report previous episodes of malaria. This fact could represent an important risk for immunosuppressed recipients that could develop severe malaria cases. We report a case of hematopoietic stem cell transplant (HSCT) in which the donor had a history of previous malaria, and close monitoring was performed before and after procedure by parasitological and molecular tests. The donor presented Plasmodium vivax in thick blood smears one month after transplant and was treated according to Brazilian Health Ministry guidelines. The polymerase chain reaction (PCR) was able to detect malaria infection in the donor one week earlier than thick blood film. Even without positive results, the recipient was pre-emptively treated with chloroquine in order to prevent the disease. We highlight the importance of monitoring recipients and donors in transplant procedures with the aim of reducing the risk of malaria transmission.

Still Searching for a Suitable Molecular Test to Detect Hidden Plasmodium Infection: A Proposal for Blood Donor Screening in Brazil

“…Malaria diagnosis remains a challenge for the detection of low parasitemias and more sensitive diagnostic tools are needed for the screening of asymptomatic infections in blood donations and transplantation products [ 1 – 3 ]. Microscopy remains the gold standard due to its low cost.…”

Parasitic infections in hematopoietic stem cell transplant recipients

“…54 P. vivax and P. ovale can persist in humans for years as hypnozoites in the liver, despite their latent nature there have been three cases of P. vivax reported in the setting of HSCT. [55][56][57] In HSCT patients, malaria has been reported as reactivation in hosts who suffered a previous infection, 56,57 through an infected donor, [58][59][60][61][62][63] or, less commonly, by transfusion of infected blood products around the time of transfusion. 64,65 While de novo infection by Anopheles mosquito inoculation in endemic areas is also possible, as evident in SOT patients, 66 there have been no reported cases in HSCT patients.…”

“…54,67 There are also molecular diagnostic methods using DNA hybridization and PCR for DNA and mRNA amplification that are much more sensitive than using blood films and are able to detect low levels of parasitemia even 1 week earlier than thick blood film. 55 Serology can also be used to investigate potential donors for malaria however it can be falsely negative during acute disease. 54 Treatment of malaria takes into account the species and drug sensitivity of parasites from the region of acquisition.…”

Transmission of malaria from donors to solid organ transplant recipients: A case report and literature review

“…21 Pre-transplant screening based on thick and thin blood smears is indicated only in endemic regions; however, this type of screening may not be sufficient to safely rule out persistent malaria because donors can have a very low level of parasitemia or have inactive parasitic forms such as hypnozoites, which cannot be detected by the gold standard test or by detecting antibodies. 22 Alternative diagnostic techniques that are recommended in some circumstances to screen blood donors may also be helpful for SOT. 23 Serology could be of use when investigating the risk from a potential donor; however, serology depends on whether the infection is acute or chronic.…”