Plasmodium falciparum

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Time to detection: 
8 days from onset symptoms.
Alerting signals, symptoms, evidence of occurrence: 
75 year old woman with fever, diarrhea, abdominal pain and jaundice, 2 weeks after prosthetic hip replacement, received blood transfusion post-operatively. Misdiagnosed as cholecystitis, diagnosed with P. falciparum parasitemia 8 days after symptom onset. Patient died. Got 2 red blood cell units from 2 donors. One donor from malaria endemic country.
Demonstration of imputability or root cause: 
Donor and recipient were both PCR positive for P. falciparum but no sequencing comparisons were done. It is possible that the two infections were truly present and unrelated, but this is a very unlikely scenario. The transmission occurred despite extensive routine screening (the donor had not been to an endemic area for 3 years, and had negative malaria antibody). Subsequent non-routine testing was done include negative thick/thin smear, negative indirect immunoflourescence, and the positive PCR.
Imputability grade: 
2 Probable
Suggest new keywords: 
Plasmodium falciparum
Suggest references: 
1) Joseph C, et al. Tropical infection after a case of total hip arthroplasty. J Hosp Infect. 87(3):179-81, 2014 Jul. 2) Anand A, et al. Investigation of a case of suspected transfusion-transmitted malaria.Transfusion. 2018 Sep;58(9):2115-2121. 3) Maier CL,et al. Transfusion-transmitted malaria masquerading as sickle cell crisis with multisystem organ failure. Transfusion. 2018 Jun;58(6):1550-1554 4) Ladeb S, et al. Plasmodium falciparum infection transmitted by transfusion: A cause of hemophagocytic syndrome after bone marrow tranplantation in a non-endemic country. Transpl Infect Dis. 2018 Jun;20(3):e12887 Mungai et al NEJM 2001 Owusu-Ofori et al Clin Inf Dis 2010 Verra et al Malar J 2018
Can we please format publications at a later time
Expert comments for publication: 
Transfusion-transmitted malaria is rarely identified, but its incidence may be higher than appreciated and is difficult to detect in endemic areas. Transmission occurs in whole blood, red blood cells, and rarely in platelets that have residual red cells. Plasmodium spp. can survive at refrigerated temperatures. P falciparum is a relapsing illness and can recur for as long as 3-4 years after initial infection, and infected donors (particularly those partially immune) may not be detected even with screening using direct microscopy. The authors have a referenced statement that even the most sensitive plasmodium DNA assay is still 100-fold short of the required sensitivity to detect all infectious units. This event occurred in France, and the authors state that their screening methods are sufficient to keep in check most of the potential for malaria transfusion, and that further changes (such as extending the deferral period) may affect the availability of blood.