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Donor‐imported and transmitted malaria after lung transplantation

Two weeks after undergoing lung transplantation for smoking-related chronic obstructive pulmonary disease with emphysema, a 63-year-old woman complained of pain in the right hypochondrium (probably related to a pleural effusion). Along with an elevated leukocyte count (15.4 9 10/l), the automated blood count (XS1000 Sysmex, Kobe, Japan) revealed thrombocytosis (565 9 10/l). Examination of a blood film unexpectedly found that 6% of her red blood cells were infected with Plasmodium ovale (image, May– Gr€ unwald–Giemsa, 960 objective). This finding was puzzling: anaemia (haemoglobin concentration 86 g/l) is common after transplantation, fever was absent, lung transplantation had taken place in a malaria-free area and the lung recipient had never travelled to areas with endemic malaria. Although the donor had lived in Africa for several years, his pre-transplantation polymerase chain reaction (PCR) testing for malaria was negative. However, PCR blood testing was positive in the lung recipient, in a frozen sample from the donor, in the lung preservation solution (frozen sample) and also in a second patient, the liver recipient. Tests on two kidney recipients were negative. Of note, none of the recipients developed clinical signs of malaria. Both infected recipients were treated and parasite eradication was achieved. In summary, blood film examination led to early diagnosis and treatment of malaria in these particularly vulnerable (immunocompromised) patients.