title: Serial nosocomial transmission of Plasmodium falciparum malaria from patient to nurse to patient.
abstract: BACKGROUND
  Nosocomial transmission of malaria is a rare phenomenon in the United States.
  
  
  OBJECTIVE
  To describe the probable transmission of Plasmodium falciparum malaria from a patient to a healthcare worker and then from the healthcare worker to another patient.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Two community hospitals in Massachusetts.
  
  
  METHODS
  Routine medical and supportive care.
  
  
  METHODS
  Clinical and laboratory evaluation.
  
  
  RESULTS
  A nurse developed falciparum malaria after a needlestick injury from a patient with documented falciparum malaria. Three days prior to her diagnosis, she cared for another patient, who subsequently developed falciparum malaria. That patient's parasite isolate genetically matched the nurse's isolate by two independent DNA fingerprinting techniques.
  
  
  CONCLUSIONS
  After extensive evaluation, we believe that a nurse who had acquired falciparum malaria via needlestick subsequently transmitted malaria to another patient via a break in standard precautions. The implications of this mechanism of transmission are discussed.
authors.affiliation: Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Alweis
authors.forename: Kerrie
authors.initials: K
authors.lastname: DiRosario
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conidi
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
authors.forename: Richard
authors.initials: R
authors.lastname: Olans
authors.forename: John L
authors.initials: JL
authors.lastname: Tully
mesh_terms: D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects; D005260:Female; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D017757:Infectious Disease Transmission, Professional-to-Patient; D016778:Malaria, Falciparum / Q000209:etiology / Q000635:transmission*; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D016602:Needlestick Injuries / Q000469:parasitology; D009741:Nursing Staff, Hospital