Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease
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...
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| Format: | Article |
| Language: | English |
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BMC
2018-01-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12936-017-2152-x |
| _version_ | 1811259382081519616 |
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| author | Paul M. Luethy Sean C. Murphy Annette M. Seilie Yingda L. Xie Chuen-Yen Lau John F. Tisdale Matthew M. Hsieh Jessica L. Reinhardt Anna F. Lau Gary A. Fahle |
| author_facet | Paul M. Luethy Sean C. Murphy Annette M. Seilie Yingda L. Xie Chuen-Yen Lau John F. Tisdale Matthew M. Hsieh Jessica L. Reinhardt Anna F. Lau Gary A. Fahle |
| author_sort | Paul M. Luethy |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T18:30:31Z |
| format | Article |
| id | doaj.art-c337a5a445c34c41b636e16d1da824ce |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-04-12T18:30:31Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-c337a5a445c34c41b636e16d1da824ce2022-12-22T03:21:06ZengBMCMalaria Journal1475-28752018-01-011711510.1186/s12936-017-2152-xDiagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell diseasePaul M. Luethy0Sean C. Murphy1Annette M. Seilie2Yingda L. Xie3Chuen-Yen Lau4John F. Tisdale5Matthew M. Hsieh6Jessica L. Reinhardt7Anna F. Lau8Gary A. Fahle9Microbiology Service, Department of Laboratory Medicine, National Institutes of HealthDepartment of Laboratory Medicine, University of WashingtonDepartment of Laboratory Medicine, University of WashingtonNational Institute of Allergy and Infectious Diseases, National Institutes of HealthNational Institute of Allergy and Infectious Diseases, National Institutes of HealthMolecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of HealthMolecular and Clinical Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of HealthMicrobiology Service, Department of Laboratory Medicine, National Institutes of HealthMicrobiology Service, Department of Laboratory Medicine, National Institutes of HealthMicrobiology Service, Department of Laboratory Medicine, National Institutes of HealthAbstract 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.http://link.springer.com/article/10.1186/s12936-017-2152-xPlasmodium falciparumSickle cell diseaseAutosplenectomyPCRRT-PCR18S rRNA |
| spellingShingle | Paul M. Luethy Sean C. Murphy Annette M. Seilie Yingda L. Xie Chuen-Yen Lau John F. Tisdale Matthew M. Hsieh Jessica L. Reinhardt Anna F. Lau Gary A. Fahle Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease Malaria Journal Plasmodium falciparum Sickle cell disease Autosplenectomy PCR RT-PCR 18S rRNA |
| title | Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease |
| title_full | Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease |
| title_fullStr | Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease |
| title_full_unstemmed | Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease |
| title_short | Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease |
| title_sort | diagnostic challenges of prolonged post treatment clearance of plasmodium nucleic acids in a pre transplant autosplenectomized patient with sickle cell disease |
| topic | Plasmodium falciparum Sickle cell disease Autosplenectomy PCR RT-PCR 18S rRNA |
| url | http://link.springer.com/article/10.1186/s12936-017-2152-x |
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