A 5-month-old infant developed malaria 16 days after cardiac surgery. After transfusion, one must consider the possibility of transfusion-induced malaria in any patient with the triad of fever, hepatosplenomegaly, and hemolysis.Although transfusion-induced ma¬ il laria is not a new disease, we feel cases should be reported to re¬ mind physicians of the danger inher¬ ent in blood transfusion. With the large number of veterans returning from parts of the world where ma¬ laria is endemic, the potential for transfusion-induced malaria steadily increases.1-7 Currently, there are some 3,000 to 4,000 cases of malaria yearly within the United States.5-7 We have recently treated a 5-month-old pa-tient who developed malaria by trans¬ fusion. This case serves to remind physicians to consider malaria in pa¬ tients who develop spiking tempera¬ tures after transfusion. Diagnosis can usually be made by careful in¬ spection of the peripheral blood films.
Report of a CaseThe patient, a 5-month-old boy with a ventricular septal defect and severe pulmonic stenosis required a Waterston shunt (side-to-side anastomosis between the as¬ cending aorta and the right pulmonary ar¬ tery) because of severe cyanosis. During and after surgery, he received several small transfusions from a single unit of 3day-old blood. The postoperative course was uneventful, and the patient was dis¬ charged afebrile ten days later. On the 16th postoperative day, he began to have spiking fever and was readmitted two days later.Physical examination revealed a poorly developed, toxic child in moderate respira¬ tory distress. His temperature was 40.6 C; respiration rate, 68 breaths per minute; pulse rate, 180 beats per minute; and weight, 5.4 kg (less than third percentile). The skin was clear without petechiae, pal¬ lor, or icterus. The lungs were clear to per¬ cussion and auscultation. There was a grade 3/6 ejection murmur along the left lower sternal border, and the continuous