Centro de Investigaciones Clinicas (CIC), Fundación Valle del Lili, Cali, Colombia.
Infectious Disease Service, Internal Medicine Department, Fundación Valle del Lili, Cali, Colombia.
Transpl Infect Dis. 2021 Aug;23(4):e13660. doi: 10.1111/tid.13660. Epub 2021 Jul 12.
Malaria is a febrile and potentially fatal infection. It is typically transmitted to humans through the bite of Anopheles mosquitoes and less frequently can be contracted through blood transfusions, sharing contaminated needles and syringes, mother-to-child transmission, or after solid organ transplantation. Posttransplant malaria has rarely been reported in the literature, even in endemic areas. We report the cases of three solid organ recipients in which Plasmodium vivax infection was documented during postsurgical evaluation 30 days after transplant surgery. The diagnosis of donor-derived malaria was confirmed in all patients by demonstrating Plasmodium in a peripheral blood smear and by polymerase chain reaction (PCR). All recipients had symptoms. The liver transplant recipient had myalgia, arthralgia, and thrombocytopenia; the kidney transplant recipient developed acute renal failure; and the heart transplant recipient had fever, cephalalgia, and tonic-clonic seizures. Pre-transplant screening of donors and recipients from endemic regions may not be sufficient to safely rule out persistent malaria. In Colombia, according to legislation, no mandatory testing is required for the diagnosis of malaria in organ donors in nonendemic areas. Therefore, donor screening by questionnaire is the only tool for preventing transplant-borne malaria. The migratory trend from Venezuela to Colombia has increased the number of imported cases of malaria, and the infection may be present in endemic and nonendemic regions. Although donor evaluation is not standardized in current guidelines, we suggest that donors be tested for malaria with a peripheral blood smear, detection of specific IgG antibodies against Plasmodium, and techniques such as PCR, if possible.
疟疾是一种发热性且可能致命的感染。它通常通过疟蚊叮咬传播给人类，也可通过输血、共用受污染的针具和注射器、母婴传播或实体器官移植而感染。移植后疟疾在文献中很少有报道，即使在流行地区也是如此。我们报告了三例实体器官受者的病例，他们在移植手术后 30 天的术后评估中被确诊为间日疟原虫感染。所有患者均通过外周血涂片和聚合酶链反应（PCR）证实疟原虫来确诊供体来源的疟疾。所有受者均有症状。肝移植受者出现肌痛、关节痛和血小板减少症；肾移植受者发生急性肾衰竭；心脏移植受者出现发热、头痛和强直阵挛性发作。来自流行地区的供者和受者的移植前筛查可能不足以安全排除持续性疟疾。在哥伦比亚，根据立法，非流行地区的器官供者无需强制性检测疟疾即可诊断。因此，通过问卷进行供者筛查是预防移植传播疟疾的唯一工具。从委内瑞拉到哥伦比亚的移民趋势增加了输入性疟疾病例的数量，这种感染可能存在于流行和非流行地区。尽管现行指南中未标准化供者评估，但我们建议对供者进行疟疾检测，包括外周血涂片、针对疟原虫的特异性 IgG 抗体检测，以及可能的 PCR 等技术。
