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Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease
- Source :
- Malaria Journal, Malaria Journal, Vol 17, Iss 1, Pp 1-5 (2018)
- Publication Year :
- 2017
-
Abstract
- Background Autosplenectomy, as a result of sickle cell disease, is an important risk factor for severe malaria. While molecular methods are helpful in providing rapid and accurate infection detection and species identification, the effect of hyposplenism on result interpretation during the course of infection should be carefully considered. Case presentation A 32-year old autosplenectomized Nigerian male with severe sickle cell disease was referred to the National Institutes of Health for allogenic hematopoietic stem cell transplant. Despite testing negative for malaria by both smear and PCR 2 weeks after arrival in the USA, the patient developed fever and diffuse bilateral lower rib cage and upper abdominal pain 2 weeks later and subsequently tested positive for Plasmodium falciparum. Parasitaemia was tracked over time by microscopy and nucleic acid tests to evaluate the therapeutic response in the setting of hyposplenism. The patient showed prompt resolution of patent infection by microscopy but remained positive by molecular methods for > 30 days after treatment initiation. Conclusion While molecular testing can provide sensitive Plasmodium nucleic acid detection, the persistence of Plasmodium nucleic acids following adequate treatment in functionally asplenic patients can lead to a diagnostic dilemma. In such patients, clinical response and peripheral blood smears should guide patient management following treatment. Nonetheless, in pre-transplant patients at high-risk for pre-existing Plasmodium infections, highly sensitive molecular assays can be useful to rule out infection prior to transplantation.
- Subjects :
- 0301 basic medicine
Male
Time Factors
Case Report
Disease
Polymerase Chain Reaction
0302 clinical medicine
Nucleic Acids
NAAT
Malaria, Falciparum
Microscopy
biology
Autosplenectomy
18S rRNA
Infectious Diseases
Real-time polymerase chain reaction
PCR
Drug Monitoring
Adult
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
lcsh:RC955-962
030231 tropical medicine
Plasmodium falciparum
RT-PCR
Anemia, Sickle Cell
lcsh:Infectious and parasitic diseases
03 medical and health sciences
Antimalarials
Internal medicine
parasitic diseases
medicine
Humans
lcsh:RC109-216
Risk factor
business.industry
Sickle cell disease
DNA, Protozoan
medicine.disease
biology.organism_classification
Nucleic acid amplification test
United States
Transplantation
030104 developmental biology
Parasitology
business
Malaria
Subjects
Details
- ISSN :
- 14752875
- Volume :
- 17
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Malaria journal
- Accession number :
- edsair.doi.dedup.....1f85ed605c868b4a6b1c181ec59eb3e3