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Adverse Occurrence type:
Time to detection:
15 - 17 days
Alerting signals, symptoms, evidence of occurrence:
The heart recipient presented fever of 38.5°C, chills, and hypotension requiring fluid replacement and noradrenaline, low hemoglobinemia, abdominal pain in the left upper quadrant due to a splenic infarct, high bilirubinemia. The donor was a previously healthy 34-year-old male from Mali, who died from head trauma. He had moved to Europe 1 year prior to his death. As recommended in the case of donors from sub-Saharan Africa, a peripheral blood smear to exclude malaria was performed, with a negative result. Retrospective testing demonstrated the donor was positive for malarial antibodies.
Demonstration of imputability or root cause:
Peripheral blood smear of the recipient showed intracellular parasites compatible with P. falciparum. Treatment with quinine, doxycycline and artesunate was administered. The patient recovered completely. Retrospective testing of the donor for P. falciparum antibodies by indirect immunofluorescence was positive. The bilateral lung recipient developed fever and had positive blood film, he responded to quinine and doxycycline treatment. The liver recipient was also treated following a positive antigen result in blood, and remained asymptomatic. The pancreas kidney and kidney recipients received prophylactic treatment with atovaquone-proguanil and remained asymptomatic.
Suggest new keywords:
Sabe N, Gonzalez-Costello J, Oriol I, Sanchez-Salado JC, Ortega S, Oliver E, et al. Donor-transmitted malaria after heart transplant managed successfully with artesunate. Transplant infectious disease : an official journal of the Transplantation Society. 2014;16(6):999-1002.
key words?ok were the patients who received prophylaxis tested serologically , did they seroconvert or not?
Expert comments for publication:
In nonendemic areas, the diagnosis of malaria should be considered in SOT recipients with febrile illness who have received an organ from a donor with epidemiologic risk, as early treatment improves prognosis. Prompt notification of other transplant centers is mandatory in cases of multiorgan donation. Testing of asymptomatic donors with epidemiological risk for malaria will have different degrees of sensitivity, depending on strategy used.