POSTTRANSPLANT MALARIA

The frequency and clinical characteristics of plasmodium infection wer e reported in 420 renal transplant recipients who were followed in the Transplantation Unit and Out-Patient Clinic of the Medical School of Istanbul. Plasmodium infection was diagnosed in eleven (9 male, 2 fema le) of the 420 patients (2.6%). Ten of the patients were transplanted in India, and one in our institution. The mean duration between the tr ansplantation and the diagnosis of malaria was 21.7 + 44.4 days in pat ients who were transplanted in India. All of the patients were taking triple immunosuppressive drugs (CsA, AZA PRED). Plasmodium falciparum was diagnosed in 6 patients, P vivax in 1 patient and P malariae in 1 patient. Also mixed infection with P falciparum and P malariae was dia gnosed in 3 patients. After definite diagnosis, the patients were hosp italized. Chloroquine phosphate plus primaquine phosphate was administ ered for P vivax infection, whereas chloroquine phosphate alone was gi ven for P falciparum and P malariae infection as a first line antimala rial therapy. As a result of therapy, infection improved clinically an d the plasmodia disappeared rapidly from the thick blood film in 10 of the patients. Severe hemolysis and acute renal failure developed in o ne patient, who improved after hemodialysis therapy and exchange trans fusions. It was concluded that malaria is quite a frequent infection o f transplant recipients who get their allografts from donors living in high-risk areas, and all transplant recipients having this kind of tr ansplantations should be suspected and examinedfor malaria. This may h elp to diagnose and treat the complication in the early period, thus r esulting in an improved prognosis for this potentially life-threatenin g complication of the posttransplant period.