输血传播恶性疟疾实验室检测和溯源分析——附报告1例

Laboratory testing and traceability analysis of one case of transfusion transmitted plasmodium falciparum malaria

目的通过对有输血史的恶性疟疾感染者进行检测和溯源分析,确定其传染源和传播方式。方法对患者和为其输血的8名献血者血样进行疟疾快速检测、血涂片镜检和Real-time PCR检测,并对阳性血样进行分子溯源和基因分型。结果患者与1名非洲返乡献血者在疟疾快速诊断试剂检测、血涂片镜检和Real-time PCR 3项检测中,均显示为恶性疟阳性。两者血样SSU rRNA基因序列两两比对后同源性为100%,Pf EMP-1基因分型显示受血者和献血者血样均为恶性疟原虫K1型和MD20型混合感染。确定该患者的恶性疟确因输入非洲返乡献血者的血液而感染。讨论由于我国未将疟疾筛查列入献血前检测,因此境外返乡人员在疟疾潜伏期或复发期内参加献血易引起输血传播疟疾。采供血机构需仔细征询既往病史和外出史,并加强宣教,将经血传播的疾病控制在源头。

Objective To perform laboratory testing and traceability analysis in a falciparum malaria case which happened in August 2013 in a local patient with no history of travel but a recent history of blood transfusion, and to determine the source of infection and the transmission route of the infection. Methods The blood samples collected from the patient and eight blood donors were screened by rapid testing, microscope and real-time PCR. The positive specimens were traced using molecular methods and genotyping. Results Using the three kinds of methods mentioned above to detect the blood samples from the patient and a donor who had just returned from Africa, both turned out positive for P. falciparum. Both showed to be 100% homologous in SSU rRNA gene sequence. PfEMP-1 genotyping of blood donors and recipients showed that they both had a mixed infection of genotype K1 and MD20, thus suggesting that the patient was infected from receiving blood transfused from the carrier returning from Africa. Conclusion Since the screening of malaria is unlisted on the pre-donation testing in our country, blood donation from overseas returnees in periods of incubation or relapse can cause transmission of malaria. To reduce the incidence of blood-borne transmission of malaria, careful collection of medical history and amniocentests information should be done in blood donation and supply institutions.