Accepted Manuscript Tropical infection after a case of total hip arthroplasty C. Joseph , A. Meybeck , H. Melliez , T. Boyer , L. Fortin-Lebraud , V. Lovi , M. Douaud , M. Pradiera , E. Senneville PII:
S0195-6701(14)00129-7
DOI:
10.1016/j.jhin.2014.04.009
Reference:
YJHIN 4345
To appear in:
Journal of Hospital Infection
Received Date: 21 February 2014 Accepted Date: 29 April 2014
Please cite this article as: Joseph C, Meybeck A, Melliez H, Boyer T, Fortin-Lebraud L, Lovi V, Douaud M, Pradiera M, Senneville E, Tropical infection after a case of total hip arthroplasty, Journal of Hospital Infection (2014), doi: 10.1016/j.jhin.2014.04.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
C. Joseph et al. Short report
Tropical infection after a case of total hip arthroplasty C. Josepha, A. Meybecka,*, H. Mellieza, T. Boyerb, L. Fortin-Lebraudc, V. Lovid, M. Douauda, M. Pradiera, E. Sennevillea Infectious Diseases Department, Dron Hospital, Tourcoing, France
b c
Hematology and Transfusion Institute, University Hospital, Lille, France
Biochemistry Department, Seclin Hopital, Seclin, France
d
Haemoviligance Department, Dron Hospital, Tourcoing, France
______________________ *
RI PT
a
SC
Corresponding author. Address: Service des Maladies Infectieuses et du Voyageur, Hôpital
Dron, 128 rue du Président Coty, 59200 Tourcoing, France. Tel.: +33 3 20 69 44 37; fax: +33
M AN U
3 20 69 44 39. E-mail address: [email protected] (A. Meybeck). SUMMARY
In non-endemic areas, malaria is mainly an imported disease. This article reports a case of transfusion-related Plasmodium falciparum malaria in a non-endemic area. Despite initial clinical signs consistent with malaria, the diagnosis was not elicited because of the absence of
TE D
any identified epidemiological risk factors. The case indicates that transfusion-transmitted malaria still occurs in non-endemic countries. The role of laboratory testing to prevent and diagnose transfusion-transmitted malaria in non-endemic malaria countries is crucial.
Malaria Transfusion
AC C
Introduction
EP
Keywords:
In non-endemic areas, malaria is mainly an imported disease as a consequence of
travelling to, and migration from, endemic areas. However, Plasmodium falciparum malaria has been rarely reported in persons with no history of travel. In rare cases, malaria is acquired by the direct inoculation of infected blood during transfusion.1–3 In France, the screening of blood donations at risk of malaria transmission is performed by completing an interview and serological testing of blood donors born or raised in endemic countries. We report the first French case of P. falciparum malaria related to a blood transfusion originating from a seronegative donor. Case report
ACCEPTED MANUSCRIPT
A 75-year-old woman was admitted to Dron Hospital, Tourcoing, France, reporting fever, diarrhoea, abdominal pain, and jaundice two weeks after a prosthetic hip replacement. Her past medical history included hypothyroidism, hypertension, renal colic, hemicolectomy for a caecal adenocarcinoma, and numerous prosthetic hip replacements. The initial postoperative period was unremarkable except for the need for a blood transfusion. On admission, vital signs were normal apart from body temperature of 38.5°C. Physical
RI PT
examination revealed jaundice, abdominal tenderness, and confusion without any focal neurological deficit.
Laboratory testing showed anaemia with a haemoglobin level of 7.9 g/dL,
thrombocytopenia with a platelet count of 100 × 109/L, and a raised bilirubin level of 330
SC
mg/L (normal: 30–120 mg/L). C-reactive protein was at 1200 mg/L (normal: 0–50 mg/L). Cholecystitis was suspected and the patient was given amoxicillin–clavulanate acid. An
M AN U
abdominal ultrasound scan showed a normal gallbladder and common bile duct. The condition of the patient rapidly deteriorated. Worsening anaemia and thrombocytopenia prompted a peripheral blood smear, revealing parasites with ring forms in red blood cells. Microscopic evaluation of a thick blood film confirmed the presence of P. falciparum with 18% parasitized erythrocytes (Figure 1). A diagnosis of severe P. falciparum malaria was confirmed eight days after onset of symptoms. The patient reported no travel history to
TE D
countries endemic for malaria and she was not living near an international airport. She had received blood transfusion with two units of packed red blood cells from two different donors. One donor was born and raised in a malaria-endemic country but had been living in France for the last three years and had not returned to a malaria-endemic country since. This donor
EP
was a first-time donor. At the time of blood donation, the latter had tested negative for malaria antibodies using an indirect immunofluorescent antibody test (Kit Lab21, BioRad, Hercules,
AC C
CA, USA). Tests subsequently performed on this sample revealed a negative thick blood smear examination, negative indirect immunofluorescence for malaria antibodies, but a positive DNA polymerase chain reaction (PCR) for P. falciparum. The donor submitted further blood specimens, confirming a positive PCR for P. falciparum. Severe transfusionrelated malaria was confirmed. The patient was admitted to the intensive care unit (ICU) and received quinidine gluconate intravenously. The donor developed acute respiratory distress syndrome and died 24 days after ICU admission. Discussion We report a case of transfusion-related malaria occurring after a total hip arthroplasty in France. Despite initial clinical signs consistent with malaria, the diagnosis was not elicited in the absence of any identified epidemiological risk factors. Transfusion-related malaria is
ACCEPTED MANUSCRIPT
extremely rare in non-endemic countries, with an estimated incidence ranging from zero to two cases per million blood donations.4,5 The delay from the onset of symptoms to its diagnosis is often prolonged, resulting in high mortality rates. In the USA, from 1963 to 1999, the reported fatality rate of transfusion-transmitted malaria due to P. falciparum was 18%.4 In the present case, thin and thick blood smear examination enabled the diagnosis of malaria due to P. falciparum eight days after onset of symptoms.
RI PT
No currently employed strategy can eliminate wholly the risk of transfusion-related malaria. Transfusion services in some countries, such as France where malaria is not endemic, use data about travel history and serological tests to identify donors at risk of transmitting malaria.1,6 Two-thirds of transfusion-related malaria cases are due to failure of the screening
SC
process.4 Semi-immune donors with very low parasite densities are implicated in one-third of cases. It has been established that as few as ten parasites per unit of red cells are sufficient to transmit infection. Even the most sensitive plasmodium DNA assay is still 100-fold short of
M AN U
the required sensitivity to detect all infectious units.7 Indirect methods detecting malaria antibodies are the methods of choice to identify donors at risk of asymptomatic parasitaemia. In most countries, individuals who were born or resided in a malaria-endemic country are excluded from blood donation for at least three years.8 In France donors who have lived in a malaria-endemic country are accepted when at least four months have elapsed after their
TE D
return and an immunofluorescent antibody test is non-reactive.1 Until 2002, the French guidelines for blood donation recommended only the immunofluorescent antibody test for blood donors who had resided in a malaria-endemic country in the past three years. From September 2002, plasmodium serology was implemented for every blood donor born or raised
EP
in an endemic area. This was as a result of transfusion-related malaria caused by a blood donation from an individual living in France for four years.9 Brouwer et al. have recently
AC C
reported a transfusion-related malaria case caused by a blood donation from a non-immune traveller whose last visit to an endemic area was more than four years ago.10 Infection was due to Plasmodium malariae which may be associated with long periods of asymptomatic carriage, whereas P. falciparum is generally eliminated within two years.7 These various reports illustrate that duration of infectivity of latent malaria after leaving an endemic area is still unknown. In our case, no failure of the screening process was identified. This first report of malaria related to transfusion originating from a seronegative donor has not led to any modification to current French guidelines. In Europe, the rejection rate of blood donors at risk for transmitting malaria ranges from 0.1% to 0.6%.8 The current donor deferral policy seems sufficient to keep in check most of the potential for malaria transfusion, and extending the deferral period may affect the availability of blood.
ACCEPTED MANUSCRIPT
In conclusion, transfusion-transmitted malaria is a rare diagnosis in non-endemic countries. Physicians should be aware of this potentially lethal complication since early diagnosis could improve outcome. The role of laboratory testing to prevent and diagnose transfusion-transmitted malaria is central. Conflict of interest statement None declared.
RI PT
Funding sources None. References 1.
Garraud O, Assal A, Pelletier B, et al. Overview of revised measures to prevent malaria
2.
Centers for Disease Control and Prevention. Probable transfusion-transmitted malaria.
M AN U
Morb Mortal Wkly Rep 2003;52:1075–1076. 3.
SC
transmission by blood transfusion in France. Vox Sang 2008;95:226–231.
Slinger R, Giulivi A, Bodie-Collins M, et al. Transfusion-transmitted malaria in Canada. Can Med Assoc J 2001;164:377–379.
4.
Mungai M, Tegtmeier G, Chamberland M, Parise M. Transfusion-transmitted malaria in the United States from 1963 through 1999. N Engl J Med 2001;344:1973–1978.
5.
Kitchen AD, Barbara JAJ, Hewitt PE. Documented cases of post-transfusion malaria
TE D
occurring in England: a review in relation to current and proposed donor-selection guidelines. Vox Sang 2005;89:77–80. 6.
Zoon K. Memorandum to all registered blood establishments. Department of Health and Human Services, US Food and Drug Administration; 26 July 1994. Recommendation for
7.
EP
deferral of donors for malaria risk.
Seed CR, Kitchen A, Davis TME. The current status and potential role of laboratory
AC C
testing to prevent transfusion-transmitted malaria. Transfusion Med Rev 2005;19:229– 240. 8.
Bruneel F, Thellier M, Eloy O, et al. Transfusion-transmitted malaria. Intensive Care Med 2004;30:1851–1852.
9.
Reesink HW. European strategies against the parasite transfusion risk. Transfusion Clin Biol 2005;12:1–4.
10. Brouwer EE, van Hellemond JJ, van Genderen PJJ, Slot E, van Lieshout L, Visser LG, Wismans PJ. A case report of transfusion-transmitted Plasmodium malariae from an asymptomatic non-immune traveller. Malaria J 2013;12:439. Figure 1. Thick blood film showing intra-erythrocytic parasites (May–Grünwald Giemsa stain, ×100).
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
S0195-6701(14)00129-7
DOI:
10.1016/j.jhin.2014.04.009
Reference:
YJHIN 4345
To appear in:
Journal of Hospital Infection
Received Date: 21 February 2014 Accepted Date: 29 April 2014
Please cite this article as: Joseph C, Meybeck A, Melliez H, Boyer T, Fortin-Lebraud L, Lovi V, Douaud M, Pradiera M, Senneville E, Tropical infection after a case of total hip arthroplasty, Journal of Hospital Infection (2014), doi: 10.1016/j.jhin.2014.04.009. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
C. Joseph et al. Short report
Tropical infection after a case of total hip arthroplasty C. Josepha, A. Meybecka,*, H. Mellieza, T. Boyerb, L. Fortin-Lebraudc, V. Lovid, M. Douauda, M. Pradiera, E. Sennevillea Infectious Diseases Department, Dron Hospital, Tourcoing, France
b c
Hematology and Transfusion Institute, University Hospital, Lille, France
Biochemistry Department, Seclin Hopital, Seclin, France
d
Haemoviligance Department, Dron Hospital, Tourcoing, France
______________________ *
RI PT
a
SC
Corresponding author. Address: Service des Maladies Infectieuses et du Voyageur, Hôpital
Dron, 128 rue du Président Coty, 59200 Tourcoing, France. Tel.: +33 3 20 69 44 37; fax: +33
M AN U
3 20 69 44 39. E-mail address: [email protected] (A. Meybeck). SUMMARY
In non-endemic areas, malaria is mainly an imported disease. This article reports a case of transfusion-related Plasmodium falciparum malaria in a non-endemic area. Despite initial clinical signs consistent with malaria, the diagnosis was not elicited because of the absence of
TE D
any identified epidemiological risk factors. The case indicates that transfusion-transmitted malaria still occurs in non-endemic countries. The role of laboratory testing to prevent and diagnose transfusion-transmitted malaria in non-endemic malaria countries is crucial.
Malaria Transfusion
AC C
Introduction
EP
Keywords:
In non-endemic areas, malaria is mainly an imported disease as a consequence of
travelling to, and migration from, endemic areas. However, Plasmodium falciparum malaria has been rarely reported in persons with no history of travel. In rare cases, malaria is acquired by the direct inoculation of infected blood during transfusion.1–3 In France, the screening of blood donations at risk of malaria transmission is performed by completing an interview and serological testing of blood donors born or raised in endemic countries. We report the first French case of P. falciparum malaria related to a blood transfusion originating from a seronegative donor. Case report
ACCEPTED MANUSCRIPT
A 75-year-old woman was admitted to Dron Hospital, Tourcoing, France, reporting fever, diarrhoea, abdominal pain, and jaundice two weeks after a prosthetic hip replacement. Her past medical history included hypothyroidism, hypertension, renal colic, hemicolectomy for a caecal adenocarcinoma, and numerous prosthetic hip replacements. The initial postoperative period was unremarkable except for the need for a blood transfusion. On admission, vital signs were normal apart from body temperature of 38.5°C. Physical
RI PT
examination revealed jaundice, abdominal tenderness, and confusion without any focal neurological deficit.
Laboratory testing showed anaemia with a haemoglobin level of 7.9 g/dL,
thrombocytopenia with a platelet count of 100 × 109/L, and a raised bilirubin level of 330
SC
mg/L (normal: 30–120 mg/L). C-reactive protein was at 1200 mg/L (normal: 0–50 mg/L). Cholecystitis was suspected and the patient was given amoxicillin–clavulanate acid. An
M AN U
abdominal ultrasound scan showed a normal gallbladder and common bile duct. The condition of the patient rapidly deteriorated. Worsening anaemia and thrombocytopenia prompted a peripheral blood smear, revealing parasites with ring forms in red blood cells. Microscopic evaluation of a thick blood film confirmed the presence of P. falciparum with 18% parasitized erythrocytes (Figure 1). A diagnosis of severe P. falciparum malaria was confirmed eight days after onset of symptoms. The patient reported no travel history to
TE D
countries endemic for malaria and she was not living near an international airport. She had received blood transfusion with two units of packed red blood cells from two different donors. One donor was born and raised in a malaria-endemic country but had been living in France for the last three years and had not returned to a malaria-endemic country since. This donor
EP
was a first-time donor. At the time of blood donation, the latter had tested negative for malaria antibodies using an indirect immunofluorescent antibody test (Kit Lab21, BioRad, Hercules,
AC C
CA, USA). Tests subsequently performed on this sample revealed a negative thick blood smear examination, negative indirect immunofluorescence for malaria antibodies, but a positive DNA polymerase chain reaction (PCR) for P. falciparum. The donor submitted further blood specimens, confirming a positive PCR for P. falciparum. Severe transfusionrelated malaria was confirmed. The patient was admitted to the intensive care unit (ICU) and received quinidine gluconate intravenously. The donor developed acute respiratory distress syndrome and died 24 days after ICU admission. Discussion We report a case of transfusion-related malaria occurring after a total hip arthroplasty in France. Despite initial clinical signs consistent with malaria, the diagnosis was not elicited in the absence of any identified epidemiological risk factors. Transfusion-related malaria is
ACCEPTED MANUSCRIPT
extremely rare in non-endemic countries, with an estimated incidence ranging from zero to two cases per million blood donations.4,5 The delay from the onset of symptoms to its diagnosis is often prolonged, resulting in high mortality rates. In the USA, from 1963 to 1999, the reported fatality rate of transfusion-transmitted malaria due to P. falciparum was 18%.4 In the present case, thin and thick blood smear examination enabled the diagnosis of malaria due to P. falciparum eight days after onset of symptoms.
RI PT
No currently employed strategy can eliminate wholly the risk of transfusion-related malaria. Transfusion services in some countries, such as France where malaria is not endemic, use data about travel history and serological tests to identify donors at risk of transmitting malaria.1,6 Two-thirds of transfusion-related malaria cases are due to failure of the screening
SC
process.4 Semi-immune donors with very low parasite densities are implicated in one-third of cases. It has been established that as few as ten parasites per unit of red cells are sufficient to transmit infection. Even the most sensitive plasmodium DNA assay is still 100-fold short of
M AN U
the required sensitivity to detect all infectious units.7 Indirect methods detecting malaria antibodies are the methods of choice to identify donors at risk of asymptomatic parasitaemia. In most countries, individuals who were born or resided in a malaria-endemic country are excluded from blood donation for at least three years.8 In France donors who have lived in a malaria-endemic country are accepted when at least four months have elapsed after their
TE D
return and an immunofluorescent antibody test is non-reactive.1 Until 2002, the French guidelines for blood donation recommended only the immunofluorescent antibody test for blood donors who had resided in a malaria-endemic country in the past three years. From September 2002, plasmodium serology was implemented for every blood donor born or raised
EP
in an endemic area. This was as a result of transfusion-related malaria caused by a blood donation from an individual living in France for four years.9 Brouwer et al. have recently
AC C
reported a transfusion-related malaria case caused by a blood donation from a non-immune traveller whose last visit to an endemic area was more than four years ago.10 Infection was due to Plasmodium malariae which may be associated with long periods of asymptomatic carriage, whereas P. falciparum is generally eliminated within two years.7 These various reports illustrate that duration of infectivity of latent malaria after leaving an endemic area is still unknown. In our case, no failure of the screening process was identified. This first report of malaria related to transfusion originating from a seronegative donor has not led to any modification to current French guidelines. In Europe, the rejection rate of blood donors at risk for transmitting malaria ranges from 0.1% to 0.6%.8 The current donor deferral policy seems sufficient to keep in check most of the potential for malaria transfusion, and extending the deferral period may affect the availability of blood.
ACCEPTED MANUSCRIPT
In conclusion, transfusion-transmitted malaria is a rare diagnosis in non-endemic countries. Physicians should be aware of this potentially lethal complication since early diagnosis could improve outcome. The role of laboratory testing to prevent and diagnose transfusion-transmitted malaria is central. Conflict of interest statement None declared.
RI PT
Funding sources None. References 1.
Garraud O, Assal A, Pelletier B, et al. Overview of revised measures to prevent malaria
2.
Centers for Disease Control and Prevention. Probable transfusion-transmitted malaria.
M AN U
Morb Mortal Wkly Rep 2003;52:1075–1076. 3.
SC
transmission by blood transfusion in France. Vox Sang 2008;95:226–231.
Slinger R, Giulivi A, Bodie-Collins M, et al. Transfusion-transmitted malaria in Canada. Can Med Assoc J 2001;164:377–379.
4.
Mungai M, Tegtmeier G, Chamberland M, Parise M. Transfusion-transmitted malaria in the United States from 1963 through 1999. N Engl J Med 2001;344:1973–1978.
5.
Kitchen AD, Barbara JAJ, Hewitt PE. Documented cases of post-transfusion malaria
TE D
occurring in England: a review in relation to current and proposed donor-selection guidelines. Vox Sang 2005;89:77–80. 6.
Zoon K. Memorandum to all registered blood establishments. Department of Health and Human Services, US Food and Drug Administration; 26 July 1994. Recommendation for
7.
EP
deferral of donors for malaria risk.
Seed CR, Kitchen A, Davis TME. The current status and potential role of laboratory
AC C
testing to prevent transfusion-transmitted malaria. Transfusion Med Rev 2005;19:229– 240. 8.
Bruneel F, Thellier M, Eloy O, et al. Transfusion-transmitted malaria. Intensive Care Med 2004;30:1851–1852.
9.
Reesink HW. European strategies against the parasite transfusion risk. Transfusion Clin Biol 2005;12:1–4.
10. Brouwer EE, van Hellemond JJ, van Genderen PJJ, Slot E, van Lieshout L, Visser LG, Wismans PJ. A case report of transfusion-transmitted Plasmodium malariae from an asymptomatic non-immune traveller. Malaria J 2013;12:439. Figure 1. Thick blood film showing intra-erythrocytic parasites (May–Grünwald Giemsa stain, ×100).
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M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
