Malaria after liver transplantation. A report of two cases and a review of published cases

Abstract

Malaria is a tropical disease that is rarely reported in liver transplant (LT) recipients.
Case 1: A 54-year-old male visited the emergency room (ER) 30 days after LT due to malaise, fever, chills, thrombocytopenia and anemia. Plasmodium vivax parasites were detected and treatment with artemether/lumefantrine was started, achieving the resolution of parasitemia. Neither chloroquine nor primaquine were prescribed because there was no stock in the country. Two months later, the patient returned to the emergency room with the same symptoms and was diagnosed with a relapse of P. vivax malaria. Treatment with chloroquine and primaquine, which were already available, was started and he was successfully treated. Given that the liver donor came from a malaria-endemic area, the infection was considered to be of donor origin, likely by hypnozoites present in the allograft. Case 2: A 58-year-old woman living in a malaria-endemic region presented to the emergency department with fever, malaise, arthralgia, cytopenias, and hypertransaminasemia six months after undergoing a liver transplant. P. vivax parasites were detected in the blood smear, so treatment with chloroquine and primaquine was started. The blood smear became negative and the patient was discharged. In this case, the mechanism of infection was likely mediated by the vector in its endemic area of residence, or more remotely by infection derived from the graft since it occurred after 6 months of the procedure.
The two cases described here add to the 15 cases of malaria in LT recipients that have been reported previously.