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Post-transfusion acquired malaria complicating orthotopic liver transplantation
D G Talabiska1, M J Komar, D H Wytock
1Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania.
Abstract:
Early infectious complications within the first 3 months of orthotopic liver transplantation are common and are associated with significant morbidity and mortality. Here we report the first case of transfusion-acquired malaria in an orthotopic liver transplantation recipient. The patient was found to have Plasmodium ovale malaria during evaluation of a severe febrile illness. The infection was traced to a platelet transfusion and responded to treatment with chloroquine. Risk factors associated with the development of malaria infection are identifiable and should be reviewed from the recipient and donor when possible. Routes of infection in the liver transplant patient would include blood products, the organ itself, and resurgence of latent infection. Theoretically, immunosuppression may have an impact on the disease process. Clinicians caring for these patients need to have a high index of suspicion in order to diagnose and treat malaria effectively in the post-transplant setting. Although rare, malaria should be added to the list of pathogens that can infect organ transplant recipients.
Insights
Transfusion-acquired malaria is a rare complication in liver transplant recipients. Early diagnosis and treatment are crucial for managing this serious infection in immunocompromised patients.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Hematology
Background:
- Early infectious complications are frequent in orthotopic liver transplantation (OLT), leading to significant morbidity and mortality.
- Opportunistic infections and reactivation of latent pathogens are common concerns in post-transplant patients due to immunosuppression.
Observation:
- A case of Plasmodium ovale malaria was diagnosed in an OLT recipient during evaluation for severe febrile illness.
- The malaria infection was identified as transfusion-acquired, originating from a platelet transfusion.
Findings:
- The patient's malaria infection responded effectively to treatment with chloroquine.
- Identifiable risk factors for malaria infection in transplant recipients, including donor and recipient screening, should be considered.
Implications:
- Malaria represents a rare but potential pathogen in organ transplant recipients, necessitating a high index of suspicion for diagnosis.
- Clinicians must be vigilant for malaria in post-OLT patients, considering blood products, the transplanted organ, and latent infection reactivation as potential routes.
- Immunosuppression's theoretical impact on malaria disease progression warrants further investigation in this vulnerable population.
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