A systematic review of transfusion-transmitted malaria in non-endemic areas

Abstract

BackgroundTransfusion-transmitted malaria (TTM) is an accidental Plasmodium infection caused by whole blood or a blood component transfusion from a malaria infected donor to a recipient. Infected blood transfusions directly release malaria parasites in the recipient’s bloodstream triggering the development of high risk complications, and potentially leading to a fatal outcome especially in individuals with no previous exposure to malaria or in immuno-compromised patients. A systematic review was conducted on TTM case reports in non-endemic areas to describe the epidemiological characteristics of blood donors and recipients.MethodsRelevant articles were retrieved from Pubmed, EMBASE, Scopus, and LILACS. From each selected study the following data were extracted: study area, gender and age of blood donor and recipient, blood component associated with TTM, Plasmodium species, malaria diagnostic method employed, blood donor screening method, incubation period between the infected transfusion and the onset of clinical symptoms in the recipient, time elapsed between the clinical symptoms and the diagnosis of malaria, infection outcome, country of origin of the blood donor and time of the last potential malaria exposure.ResultsPlasmodium species were detected in 100 TTM case reports with a different frequency: 45% Plasmodium falciparum, 30% Plasmodium malariae, 16% Plasmodium vivax, 4% Plasmodium ovale, 2% Plasmodium knowlesi, 1% mixed infection P. falciparum/P. malariae. The majority of fatal outcomes (11/45) was caused by P. falciparum whilst the other fatalities occurred in individuals infected by P. malariae (2/30) and P. ovale (1/4). However, non P. falciparum fatalities were not attributed directly to malaria. The incubation time for all Plasmodium species TTM case reports was longer than what expected in natural infections. This difference was statistically significant for P. malariae (p = 0.006). A longer incubation time in the recipient together with a chronic infection at low parasite density of the donor makes P. malariae a subtle but not negligible risk for blood safety aside from P. falciparum.ConclusionsTTM risk needs to be taken into account in order to enhance the safety of the blood supply chain from donors to recipients by means of appropriate diagnostic tools.

Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges

“…A recent review of TT-malaria in non-endemic regions reported 100 cases from 1911 to 2015 with only a few cases in the twenty-first century, the two most recent cases in 2015 were from the USA [103]. Fifty-four of these cases occurred in the American continent, 38 in Europe, 3 in the Mediterranean area, 1 in India, and 4 in Southeast Asia.…”

Inactivation of Plasmodium falciparum in whole blood using the amustaline and glutathione pathogen reduction technology

“…The first case was reported by Woosley in 1911 . Transfusion‐transmitted (TT) malaria is mostly associated with RBC concentrates although transmission by plasma and platelet components has also been reported …”

“…In non‐endemic countries, TT malaria is due to infected travelers and immigrants coming from endemic areas. This kind of malaria transmission may cause severe clinical symptoms especially because recipients are often unaware or immunosuppressed . Delayed diagnosis is also a cause of significant morbidity and mortality .…”

“…3 Transfusion-transmitted (TT) malaria is mostly associated with RBC concentrates although transmission by plasma and platelet components has also been reported. 4,5 In non-endemic countries, TT malaria is due to infected travelers and immigrants coming from endemic areas. This kind of malaria transmission may cause severe clinical symptoms especially because recipients are often unaware or immunosuppressed.…”

“…This kind of malaria transmission may cause severe clinical symptoms especially because recipients are often unaware or immunosuppressed. 5 Delayed diagnosis is also a cause of significant morbidity and mortality. 6 To avoid TT infections, WHO released guidelines in 2016 for blood transfusion safety and hemovigilance criteria that are defined by each country.…”