Delay in diagnosis: malaria in a returning traveller

Boggild, Andrea K.; Page, Andrea V.; Keystone, Jay S.; Morris, Andrew M.; Liles, W. Conrad

doi:10.1503/cmaj.090171

Cited by 10 publications

(10 citation statements)

References 14 publications

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“…Although the potential advantage of the ICT (i.e. more timely identification of parasitaemic individuals) was not realized during the study, this potential benefit supports its continuation as a component of the algorithm because any delay in referring parasitaemic donors for clinical assessment may have serious health consequences [18].…”

Section: Discussionmentioning

confidence: 99%

“…The rationale for the combination of the antigen ICT and PCR to determine the requirement for clinical assessment was based on the following. The antigen ICT can be completed within hours of the RR EIA and has high sensitivity and specificity particularly for P. falciparum , the species most likely to lead to significant morbidity and mortality where diagnosis is delayed [18]. Therefore, RR Newmarket EIA/antigen ICT positive donors can be immediately referred without waiting for the PCR with high confidence as they are parasitaemic and therefore require immediate clinical assessment.…”

Section: Methodsmentioning

confidence: 99%

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Assessing the safety and efficacy of a test-based, targeted donor screening strategy to minimize transfusion transmitted malaria

et al. 2010

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Background and Objectives In 2005, the Australian Red Cross Blood Service implemented a malaria antibody testing based strategy for donors with a history of travel ⁄ residence in a malaria endemic country or a past history of malaria. This report assesses the safety and efficacy of the strategy since inception. Materials andMethods Eligible blood donors were tested using the Newmarket malarial antibody EIA at least 4 months after their last potential exposure. Where EIA non-reactive their quarantined red cells were considered for transfusion and they were re-instated for cellular component manufacture at their next donation. The efficiency and safety of this strategy were evaluated based on the additional number of components recovered for transfusion and the observed incidence of transfusion transmitted malaria (TTM) respectively.Results Of the repeat reactive donors, 2696 (> 99AE99%) were PCR negative whilst one was PCR positive with very low level parasitaemia. The average number of RBCs and platelets recovered per annum was 64 967 and 7398 representing 7AE9 and 5AE5% respectively of their annual production. No new TTM cases were recorded and the observed TTM rate of zero was consistent with the upper 95% CI for the pretesting TTM incidence of 0AE9 per million donations. ConclusionThe study findings support the efficacy and safety of a targeted screening strategy combining a sensitive antibody screening test with a 4-month cellular component restriction period for donors with a declared malarial risk. The TTM risk in Australia remains low and did not measurably change after implementing the testing strategy.Key words: blood donor, malaria, screening, transfusion. IntroductionMalaria is a protozoan parasitic infection of humans resulting from infection by one or more of the five species of the genus Plasmodium (P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi) [1,2]. Transfusion transmitted malaria (TTM), although rare, continues to pose a risk to blood services worldwide with recent transmissions invariably resulting from 'semi-immune' donors who may carry undetectable levels of parasites without overt symptoms [3][4][5][6][7][8][9]. Of the five Plasmodium species, P. falciparum is the most serious transfusion risk since it is fatal in approximately 10% of patients infected in this way [10]. Although malaria is not endemic in Australia, there are between 500 and 900 cases of imported malaria annually constituting an ongoing TTM risk [11]. The last documented Australian TTM case, a fatality associated with P. falciparum, occurred in 1991 [12], this being the first reported transfusion Due to the lack of a suitable high throughput laboratory test, screening for malaria in Australian blood donors prior to July 2005 relied on collecting a comprehensive medical and travel history as part of the donor assessment process and exclusion of cellular blood components from those with potential risk exposure to Plasmodiae. At that time, the Australian Red Cross Blood Service (ARCBS) Guidelines for the select...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Assessing the safety and efficacy of a test-based, targeted donor screening strategy to minimize transfusion transmitted malaria

et al. 2010

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“…It is therefore very important not to rule out malaria after one blood smear. In non-falciparum malaria, exclusion of diagnosis requires 3 separate blood smears, performed and promptly read at 12-hour intervals over a 24 to 48 hours period (33)(34)(35). If a dipstick assay is used, it must be followed up with confirmatory blood smears, which allows determination of species and quantification of parasitaemia.…”

Section: Resultsmentioning

confidence: 99%

Imported Malaria in a Tertiary Hospital in Belgium: Epidemiological and Clinical Analysis

Yombi¹,

Jonckheere²,

Colin³

et al. 2013

Acta Clinica Belgica

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Imported malaria cases are mostly related to the lack of adequate use of chemoprophylaxis. Plasmodium falciparum is the main species responsible for imported cases of malaria in our institution. Clinical features vary, but fever is universally present at presentation. As such, all cases of fever upon return from a malaria-endemic area must be considered as malaria until proven otherwise, at least during the first three months after the return.

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“…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 . To avoid TT infections, WHO released guidelines in 2016 for blood transfusion safety and hemovigilance criteria that are defined by each country.…”

mentioning

confidence: 99%

“…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. Generally, screening starts by a pre-donation questionnaire leading to the deferral of donors returning from travel to endemic areas.…”

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confidence: 99%

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

et al. 2020

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BACKGROUND Risk of transfusion‐transmitted (TT) malaria is mainly associated with whole blood (WB) or red blood cell (RBC) transfusion. Risk mitigation relies mostly on donor deferral while a limited number of countries perform blood testing, both negatively impacting blood availability. This study investigated the efficacy of the pathogen reduction system using amustaline and glutathione (GSH) to inactivate Plasmodium falciparum in WB. STUDY DESIGN AND METHODS WB units were spiked with ring stage P. falciparum infected RBCs. Parasite loads were measured in samples at time of infection, after 24 hours at room temperature (RT), and after a 24‐hour incubation at RT post‐treatment with 0.2 mM amustaline and 2 mM GSH. Serial 10‐fold dilutions of the samples were inoculated to RBC cultures and maintained up to 4 weeks. Parasitemia was quantified by cytometry. RESULTS The P. falciparum viability assay has a limit of detection of a single live parasite per sample. Input parasite titer was >5.7 log10 TCID50 per mL. A 24‐hour incubation at RT paused parasite development in controls, but they retained viability and infectivity when tested in culture. In contrast, no infectious parasites were detected in the amustaline/GSH‐treated sample after 4 weeks of culture. CONCLUSION A robust level of P. falciparum inactivation was achieved in WB using amustaline/GSH treatment. Parasite log reduction was >5.7 log10 TCID50 per mL. Development of such a pathogen reduction system may provide an opportunity to reduce the risk of TT malaria and improve blood availability.

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Delay in diagnosis: malaria in a returning traveller

Cited by 10 publications

References 14 publications

Assessing the safety and efficacy of a test-based, targeted donor screening strategy to minimize transfusion transmitted malaria

Assessing the safety and efficacy of a test-based, targeted donor screening strategy to minimize transfusion transmitted malaria

Imported Malaria in a Tertiary Hospital in Belgium: Epidemiological and Clinical Analysis

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

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