title: Peripheral blood stem cell transplant-related Plasmodium falciparum infection in a patient with sickle cell disease.
abstract: BACKGROUND
  Although transmission of Plasmodium falciparum (Pf) infection during red blood cell (RBC) transfusion from an infected donor has been well documented, malaria parasites are not known to infect hematopoietic stem cells. We report a case of Pf infection in a patient 11 days after peripheral blood stem cell transplant for sickle cell disease.
  
  
  METHODS
  Malaria parasites were detected in thick blood smears by Giemsa staining. Pf HRP2 antigen was measured by enzyme-linked immunosorbent assay on whole blood and plasma. Pf DNA was detected in whole blood and stem cell retention samples by real-time polymerase chain reaction using Pf species-specific primers and probes. Genotyping of eight Pf microsatellites was performed on genomic DNA extracted from whole blood.
  
  
  RESULTS
  Pf was not detected by molecular, serologic, or parasitologic means in samples from the recipient until Day 11 posttransplant, coincident with the onset of symptoms. In contrast, Pf antigen was retrospectively detected in stored plasma collected 3 months before transplant from the asymptomatic donor. Pf DNA was detected in whole blood from both the donor and the recipient after transplant, and genotyping confirmed shared markers between donor and recipient Pf strains. Lookback analysis of RBC donors was negative for Pf infection.
  
  
  CONCLUSIONS
  These findings are consistent with transmission by the stem cell product and have profound implications with respect to the screening of potential stem cell donors and recipients from malaria-endemic regions.
authors.affiliation: National Institute of Allergy and Infectious Diseases, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Rojelio
authors.initials: R
authors.lastname: Mejia
authors.forename: Garrett S
authors.initials: GS
authors.lastname: Booth
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Fedorko
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hsieh
authors.forename: Hanh M
authors.initials: HM
authors.lastname: Khuu
authors.forename: Harvey G
authors.initials: HG
authors.lastname: Klein
authors.forename: Jianbing
authors.initials: J
authors.lastname: Mu
authors.forename: Gary
authors.initials: G
authors.lastname: Fahle
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Nutman
authors.forename: Xin-Zhuan
authors.initials: XZ
authors.lastname: Su
authors.forename: Esther C
authors.initials: EC
authors.lastname: Williams
authors.forename: Willy A
authors.initials: WA
authors.lastname: Flegel
authors.forename: Amy
authors.initials: A
authors.lastname: Klion
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood / Q000628:therapy*; D016054:DNA, Protozoan / Q000235:genetics; D054242:Emigrants and Immigrants; D005260:Female; D005838:Genotype; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000635:transmission*; D010963:Plasmodium falciparum / Q000235:genetics / Q000302:isolation & purification*; D012807:Sierra Leone / Q000208:ethnology; D014481:United States
chemical_list: D016054:DNA, Protozoan