Malaria was eliminated from Sri Lanka in 2012, and since then 50–60 imported malaria cases have been reported yearly. The country has remained malaria-free since, except for a single case of indigenous malaria in 2018. Blood donors are routinely screened for malaria, and transfusion malaria has not been reported in the country since 1966. A 17-year-old splenectomized beta thalassaemia patient developed a transfusion-induced Plasmodium falciparum malaria infection following a blood transfusion 18 days earlier. The blood donor was an armed forces personnel who returned from South Sudan following a United Nations peace-keeping mission. The blood recipient’s malaria infection took a complicated clinical course with elevated liver enzymes, lowered blood pressure and a prolonged parasite clearance time of 7 days but he recovered fully after two courses of artemether-lumefantrine interrupted by a course of intravenous artesunate. The prolonged parasite clearance is likely due to lack of splenic clearance of dead or damaged intra-erythrocytic parasites (due to a splenectomy) rather than to the parasite strain being resistant to artemisinin or the partner drug. This is corroborated by the fact that the blood donor’s infection responded to artemether-lumefantrine with parasites being cleared on day 3. The blood donor who had not displayed signs or symptoms of malaria, had been screened for malaria on arrival in Sri Lanka and was negative on both microscopy and RDT. At the point of blood donation a blood smear examined microscopically was also reported negative for malaria, but retrospectively, the preserved smear of the donor’s blood was found to contain P. falciparum parasites at a very low density. The donor when tested after the transfusion-induced case was diagnosed, also tested positive for malaria and was treated. After malaria elimination, transfusion-induced malaria from blood donors returning from malaria endemic countries poses a threat to preventing the re-establishment of the disease. Improved surveillance of arrivals in Sri Lanka from malaria endemic countries using more sensitive methods for screening than microscopy may be required to reduce this risk. More stringent criteria for selecting blood donors, and more effective methods of screening donors for malaria than microscopy may also be necessary.

中文翻译：

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斯里兰卡 1 名 β 地中海贫血患者在预防重建阶段输血引起的恶性疟原虫疟疾

斯里兰卡于 2012 年消灭了疟疾，此后每年报告 50-60 例输入性疟疾病例。除了 2018 年发生一例本土疟疾病例外，该国一直无疟疾。献血者定期接受疟疾筛查，自 1966 年以来该国未报告输血疟疾。 一名 17 岁的脾切除型 β-地中海贫血患者在 18 天前输血后出现了输血诱发的恶性疟原虫疟疾感染。献血者是一名在联合国维和任务后从南苏丹返回的武装部队人员。受血者的疟疾感染经历了复杂的临床过程，肝酶升高，降低了血压并延长了 7 天的寄生虫清除时间，但在静脉注射青蒿琥酯中断了两个疗程的蒿甲醚-苯芴醇后，他完全康复了。寄生虫清除时间延长可能是由于缺乏对死亡或受损红细胞内寄生虫的脾清除（由于脾切除术），而不是由于寄生虫菌株对青蒿素或伙伴药物有抗药性。事实证明，献血者的感染对蒿甲醚-芴芴醇有反应，寄生虫在第 3 天被清除。 没有表现出疟疾迹象或症状的献血者在抵达斯里兰卡时接受了疟疾筛查，结果为阴性在显微镜和 RDT 上。在献血时，经显微镜检查的血液涂片也报告为疟疾阴性，但回顾过去，发现保存在捐献者血液的涂片中含有非常低密度的恶性疟原虫寄生虫。在诊断出输血诱发的病例后，捐赠者在接受检测时也检测出疟疾阳性并接受了治疗。疟疾消除后，从疟疾流行国家返回的献血者输血引起的疟疾对防止该疾病的复发构成威胁。可能需要使用比显微镜更敏感的筛查方法来改进对从疟疾流行国家抵达斯里兰卡的人的监测，以降低这种风险。可能还需要更严格的献血者选择标准，以及比显微镜检查更有效的疟疾献血者筛查方法。恶性疟原虫密度非常低。在诊断出输血诱发的病例后，捐赠者在接受检测时也检测出疟疾阳性并接受了治疗。疟疾消除后，从疟疾流行国家返回的献血者输血引起的疟疾对防止该疾病的复发构成威胁。可能需要使用比显微镜更敏感的筛查方法来改进对从疟疾流行国家抵达斯里兰卡的人的监测，以降低这种风险。可能还需要更严格的献血者选择标准，以及比显微镜检查更有效的疟疾献血者筛查方法。恶性疟原虫密度非常低。在诊断出输血诱发的病例后，捐赠者在接受检测时也检测出疟疾阳性并接受了治疗。疟疾消除后，从疟疾流行国家返回的献血者输血引起的疟疾对防止该疾病的复发构成威胁。可能需要使用比显微镜更敏感的筛查方法来改进对从疟疾流行国家抵达斯里兰卡的人的监测，以降低这种风险。可能还需要更严格的献血者选择标准，以及比显微镜检查更有效的疟疾献血者筛查方法。从疟疾流行国家返回的献血者输血诱发的疟疾对防止这种疾病的复发构成威胁。可能需要使用比显微镜更敏感的筛查方法来改进对从疟疾流行国家抵达斯里兰卡的人的监测，以降低这种风险。可能还需要更严格的献血者选择标准，以及比显微镜检查更有效的疟疾献血者筛查方法。从疟疾流行国家返回的献血者输血诱发的疟疾对防止这种疾病的复发构成威胁。可能需要使用比显微镜更敏感的筛查方法来改进对从疟疾流行国家抵达斯里兰卡的人的监测，以降低这种风险。可能还需要更严格的献血者选择标准，以及比显微镜检查更有效的疟疾献血者筛查方法。