Martín-Dávila Pilar, Norman Francesca, Fortún-Abete Jesus, Píris Miguel, Lovatti Ruben, Rubio Jose Miguel, Martinez-Pérez Adolfo, Graus Javier, Ta Gema, Villarubia Jesus, Mahillo Beatriz, López-Vélez Rogelio
Infectious Diseases Department, Transplant Infection Unit, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain.
Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Madrid, Spain.
Transpl Infect Dis. 2018 Oct;20(5):e12938. doi: 10.1111/tid.12938. Epub 2018 Jul 11.
A 57-year-old man was admitted with fever and thrombocytopenia 1 month after renal transplantation. He had never received a blood transfusion or travelled outside Spain. A peripheral blood smear revealed Plasmodium malariae and P. ovale parasites, diagnosis confirmed later by malaria PCR. The donor, from Equatorial Guinea, had negative thick and thin blood smears and rapid malaria antigen test prior to organ donation. Peripheral blood malaria PCR was not performed during donor screening. The second renal recipient and the liver recipient were evaluated and were found to be asymptomatic. Thick and thin films and rapid malaria diagnostic tests were negative for both patients and blood for malaria PCR was sent to the referral laboratory. The index patient was treated with oral chloroquine diphosphate, with a favorable outcome and was considered cured. Malaria PCR was negative for the other renal recipient and positive for P. malariae and P. ovale curtisi for the liver transplant patient. Both were treated with oral chloroquine and the liver recipient also completed treatment with primaquine phosphate. This reported case of multiorgan transmission of mixed malaria infection highlights the importance of PCR-based tests for Plasmodium in the screening of donors from endemic areas.
一名57岁男性在肾移植术后1个月因发热和血小板减少入院。他从未接受过输血，也未曾去过西班牙以外的地方。外周血涂片显示有间日疟原虫和卵形疟原虫，疟疾PCR检测后来确诊了该诊断。供体来自赤道几内亚，在器官捐献前厚血膜和薄血膜涂片以及快速疟疾抗原检测均为阴性。供体筛查期间未进行外周血疟疾PCR检测。对第二名肾移植受者和肝移植受者进行了评估，发现他们没有症状。两名患者的厚血膜和薄血膜涂片以及快速疟疾诊断检测均为阴性，已将用于疟疾PCR检测的血液样本送往转诊实验室。索引患者接受了口服磷酸氯喹治疗，结果良好，被认为已治愈。另一名肾移植受者的疟疾PCR检测为阴性，肝移植患者的检测结果显示感染了间日疟原虫和柯氏卵形疟原虫。两人均接受了口服氯喹治疗，肝移植受者还完成了磷酸伯氨喹的治疗。这例报告的混合疟疾感染多器官传播病例凸显了基于PCR的疟原虫检测在筛查来自流行地区供体中的重要性。
