title: Patient-to-patient transmission of nosocomial malaria in Italy.
abstract: OBJECTIVE
  To describe nosocomial transmission of malaria from patient to patient via blood exposure.
  
  
  METHODS
  A 56-year-old man was admitted to an Italian hospital with fever and Plasmodium falciparum parasitemia, but with no risk factors for malaria. Twenty days earlier, he had been admitted for bronchopulmonary disease to the hospital's intensive care unit, where a woman with P. falciparum malaria acquired abroad was present.
  
  
  METHODS
  We reviewed both patients' medical records and searched for mosquitoes in the hospital and on the grounds. We interviewed the staff about patient care practices potentially involving contact with blood. The genetic identities of strains were determined by genotyping of the DNA extracted from blood.
  
  
  RESULTS
  Molecular genotyping showed that the two strains were identical. The only invasive procedures performed on both patients by the same staff on the same shift were capillary blood sampling by finger stick, intravenous drug administration, and substitution of total parenteral nutrition bags and intravenous sets. The fingerstick device used was designed to prevent person-to-person transmission of blood-borne infections, and the staff interviews did not reveal any incorrect use of aseptic techniques. The likely source of infection was identified during a training course 6 months later: a nurse reported that, when collecting blood, she placed patients' fingers directly on the blood glucose meter, a practice she had learned from a poster advertising the device.
  
  
  CONCLUSIONS
  A nosocomial case of malaria was ascertained, which was likely due to patient-to-patient transmission via a contaminated blood glucose meter. Incomplete instructions for the meter seem to have played a role in this case.
authors.affiliation: Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Moro
authors.forename: Roberto
authors.initials: R
authors.lastname: Romi
authors.forename: Carlo
authors.initials: C
authors.lastname: Severini
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Casadio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sarta
authors.forename: Guido
authors.initials: G
authors.lastname: Tampieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Scardovi
authors.forename: Cinzia
authors.initials: C
authors.lastname: Pozzetti
mesh_terms: D003428:Cross Infection; D018562:Disease Transmission, Infectious; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D016778:Malaria, Falciparum / Q000469:parasitology / Q000635:transmission*; D008297:Male; D008875:Middle Aged