Malaria in renal transplant recipients: an interesting problem in tropical medicine

Dear Sir,

Malaria is one of the most common mosquito borne infectious diseases. It is a parasitic disease caused by single cell protozoa in the species, Plasmodium. The acute febrile illness with deadly complications is the main characteristic of this infection. Malaria can be seen around the world especially those countries in the tropical zone. It is accepted as important in tropical medicine and cause several deaths each year. The malaria infection in renal transplant recipients is an interesting problem that is little mentioned. Although it is accepted that malaria can be transmitted via the organ transplantation ^[1],[2],[3] and it is the rule to screen for malaria in transplantation process, ^[4],[5] it does not mean that the post transplant recipients will not take further chance to get malaria in their post transplantation lives. Here, the author performed a retrospective review using the electronic search engine tools, PubMed and Scopus to find the report in this area. The searching key words include “renal”, “transplantation,” and “malaria.” The derived publications which described the malaria in transplant recipients are included. The repots without complete data as well as those that described the specific infection relating to the transplantation process or donated organ were excluded. The clinical characteristics of the all recruited cases were summarized, analyzed and presented. Of interest, there is no report with clear evidence of new episode of malaria infection in renal transplant recipient that is clearly not relating to transplantation process although there are some reports that might be the cases in this category. ^[6],[7],[8] There are many reasons for lack of evidence including a) lack for concern of the case or under-diagnosis, b) underreporting, and c) there is actually no new cases (which is hardly to possible).

Indeed, malaria is an important infection in renal transplant recipients. It is not controversial that the infection can cause deterioration of renal function and renal failure. Due to the immunosuppressive status, the clinical manifestation of malaria might be delayed and the diagnosis might be difficult if it is not kept in mind. ^[9] It is also proved that organ transplantation can be the cause of the malarial transmission. Recently, Hung, et al. studied the cases of transplantation related malaria in renal transplant recipients and concluded that “malaria is quite a frequent infection of transplant recipients who get their allografts from donors living in high-risk areas, and all transplant recipients having this kind of transplantations should be suspected and examined for malaria. ^[9]” In many reports, ^{[9],[10],[11],[12]} the patients developed within 1 month after organ transplantation and the countries where the organs were donated include India, Iran, Pakistan, etc. Apart from the contaminated organs, the blood transfusion during the transplantation operation is another important etiology of malaria infection in renal transplant recipients. Hence, it is the rule at present to screen for both blood product and donated organ for malaria before starting the transplantation process.

However, the actual problem of malaria in renal transplant recipient that is not relating to transplantation process or donated organ is not well described. Of interest, although there is no clear evidence, it is believed that the renal transplant recipients take for severe clinical manifestation if they get malaria and there are many suggestions for prevention among the renal transplant recipient traveler to the endemic area. ^[13],[14] For the endemic area, malaria prophylaxis might also be considered. According to the report ofAnteyi et al., ^[8] “prophylaxis with proguanil hydrochloride 200 mg daily” is useful and recommended.

Finally, these suggestions should be taken.

The basic pre-transplantation is still necessary. The screening for blood product and donated organ should be the rule. This is not only for malaria but also other infectious diseases.

Malaria infection can be the problem for the renal transplant recipients; hence, the general rule for prevention of mosquito borne infectious diseases is still required for this group of patient. Although the diagnosis might be difficult but the basic microscopic identification of the parasite is still the basic practice.

Malaria should be one of the differential diagnoses for unexplained fever for the renal transplant recipient. Based on the worldwide distribution of malaria at present, it should also be kept in mind of the attending physicians in any setting, tropical or non tropical countries.

Standard malaria treatment is still effective and can be used in renal transplant recipients without any problems.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.121023