Table 1 Transfusion or transplant transmitted falciparum malaria occurring at least six months after the donor’s last exposure risk

Black et al., Australia [21]

Adult female with carcinoma; peri-operative blood transfusion in 1958, with fever 7 days post transfusion. Falciparum malaria diagnosed subsequently (confirmed by microscopy 14 days after transfusion)

Merchant seaman with trips to malarious areas 1942–7 and intermittent anti-malarials. History of malaria, most recent in Solomon Islands in 1953. Back in Australia since April 1957.

Slide positive

15 months

Chojnacki et al., USA [22]

60-years-old male with anaemia and myocardial infarction transfused who developed fever and chills 4 days post transfusion with falciparum malaria confirmed subsequently

19-years-old soldier, served in Vietnam until 7 months before blood donation. Had taken prophylaxis. Recalled short fever episode in Vietnam

>20 slides negative. Sternal bone marrow aspirate + by microscopy

7 months

Fisher et al., USA [23]

Case 1: 54-years-old American female transfused during aorto-iliac bypass graft surgery in 1968. Developed fever 13 days post transfusion with falciparum malaria confirmed by microscopy nine days later. No relevant travel history

22-years-old American soldier in Vietnam 1966- March 1967. Took prophylaxis.

Positive serology; negative microscopy

13 months

Case 2: 25-years-old female, transfused for post-partum haemorrhage. Developed fever ~2 weeks later and then severe malaria with coma. Diagnosis finally made 3 weeks post transfusion.

21-years-old American soldier in Viet Nam 1967–1968. Took prophylaxis.

Negative microscopy

7 months

Brooks et al.,USA[24]

56-years-old male with laryngeal carcinoma. Post-surgical transfusion; no relevant travel history. Died of cerebral malaria about 3 weeks post operatively.

Nigerian student.

Rare P.F T seen finally after multiple negative smears and a 500 ml phlebotomy.

32 months

Dike, UK [25]

Adult male, given blood transfusion after a road traffic accident. Developed fever 19 days later and falciparum malaria confirmed 24 days after last transfusion

Nigerian student. Asymptomatic

Serology positive.

17 months

Seligman et al., USA [26]

34-years-old male. End-stage renal failure on haemodialysis, born in Italy, in USA since 1955. Monthly blood transfusions. Developed falciparum malaria in 1970 with symptoms 7 days post transfusion. No relevant travel history.

Ghanaian, immigrated to USA in Oct 1969. No history of malaria.

One P.F T ring form found on thin smear. Serology positive.

13 months

Duizabo et al., France [27]

No details^*

No details

No details

16 months

Besson et al., France [28]

30-years-old male. Orthopaedic surgical procedure (correction of pseudarthrosis) with transfusion in 1973. Fever 2 weeks later.Eventual microscopy diagnosis of falciparum malaria. Had never left France and no history of malaria.

Donor born in Senegal, living in France since 1960, no history malaria.

Serology (IF) positive

13 years

Saleun et al., France [29]

No details. P. falciparum transmitted by blood transfusion

Donor from Burkina Faso

No details

16 months

Duperval et al., Canada [30]

8-years-old Canadian male, treated for chronic lymphocytic leukaemia, admission with high fever. Cerebral malaria diagnosed post-mortem, including sequestration of parasitised erythrocytes in cerebral vasculature. Last recorded blood transfusion was post gastrectomy 12 years earlier. No travel; route/time of malaria acquisition unknown. 50% parasitaemia on pre-mortem slides examined retrospectively.

No donor history

No details

12 years

Babinet et al., France [31]

53-years-old Portuguese female with left ventricular insufficiency, admitted for heart transplant. Developed symptoms of malaria 12 days post op, diagnosed on day 18. She died 4 days later^**

51-years-old female originally from Cameroon

Donor's serum tested retrospectively was positive for P. falciparum Abs and Ag

15 months

Yarrish et al., USA [32]

65-years-old female, transfused at cardiothoracic surgery (for rheumatic mitral stenosis) in 1982. Developed post transfusion falciparum malaria with 5% parasitaemia diagnosed by microscopy 16 days post surgery. No relevant travel history.

Ghanaian male residing in USA for 6 years. Last trip to Ghana the year prior to donation

Positive P.F serology

10 months

Stickland et al., Australia [33]

83-years-old female with myelodysplastic syndrome; transfusion dependent. 1991: developed falciparum malaria 23 days post- transfusion diagnosed by microscopy of blood and bone marrow aspirate. No relevant travel history.

Donor was previously a long-term resident of Papua New Guinea.

No laboratory confirmation

8 months

Slinger et al., Canada [34]

Case 1: 62-years-old female, post transfusion falciparum malaria in 1997. No history of travel to malarious area

Donor 1: 19-years-old female from Ghana originally and living in Canada for 4 years.

Unable to get a sample for screening

4 years

Case 2: 24-years-old female developed fever 15 days post transfusion with P. falciparum confirmed 3 days later

Donor 2: male, originally from Mali. History of malaria treated with chloroquine in 1991

Donor 2: PCR positive for P.F

4 years

Case 3: 63-years-old male, P. falciparum malaria 16 days after platelet transfusion

Donor 3: Originally from Cameroon.

Donor 3: Rare P.f. T and gametocytes slide

3 years and history of malaria 13 years previously

Frey-Wettstein et al., Switzerland [35]

70-years-old male with ischaemic heart disease and aortic aneurysm, transfused peri-operatively in 1999. Developed post-transfusion falciparum malaria with symptoms 2 weeks post-op (confirmed by microscopy 1 week later) and died.

30-years-old male born in Cameroon, with history of malaria aged 15 years. Moved to Europe 10 years before blood donation. Last trip to Cameroon 6 years before.

Serology positive and later slide positive (gametocytes and P.f. T)

6 years

MMWR USA [36]

69-years-old male, transfused in 2003 following upper gastrointestinal bleed. No relevant travel history. Re-admitted 2–3 weeks post transfusion with falciparum malaria diagnosed by microscopy.

18-years-old blood donor of Ghanaian origin living in USA for 11 months. Treated for malaria 2 years previously.

Slide and PCR negative. Serology (IFA) positive.

11 months

Bruneel et al., France [37]

81-years-old male, Type 2 diabetes mellitus, post transfusion cerebral malaria and death in 2002. Symptoms developed 2 weeks post transfusion. No travel to an endemic area for 20 years.

19-years-old female, originally from sub-Saharan Africa. Living in France for 4 years

Positive PCR for P.falciparum and negative thick film' in the 'Diagnostic test results for donor'

4 years

Kitchen, UK [38]

Case 1: 72-years-old female with acute leukaemia, never visited malarious area. Developed falciparum malaria 13 days after multiple blood product transfusions (probably from platelet transfusion)

Male, UK born, worked in Africa for 10 years and history of malaria.

Serology (IFAT) positive

2 years

Case 2: Male with diabetes and Non-Hodgkins Lymphoma, presenting with falciparum malaria more than 2 weeks after a transfusion. Travelled to Kenya the year before

Female, Nigerian but UK resident since childhood. Three trips to Ghana

Serology (EIA and IFAT) positive

6 months

Case 3: 62-years-old male, fever 4 days post transfusion for gastrointestinal bleeding in 1997. Served in Egypt in WWII. Otherwise no travel. Died of cerebral malaria.

19-years-old, Ghanaian female. UK national since aged 6 months. Travelled to Uganda in 1994 travelled to Uganda for 6 weeks where she reported undiagnosed fever.

Slide negative. Serology (EIA and IFAT) positive

3 years

Case 4: 51-years-old male with sickle cell anaemia and chronic renal failure. Post transfusion falciparum malaria in 2003. No history of travel to malarious area. Left Jamaica for UK in 1957.

38-years-old female, Ghanaian, visited Ghana last in 1996

Slide positive Serology (EIA and IFAT) positive

7 years

MMWR USA [39]

25-years-old female with sickle cell anaemia, multiple transfusions in 2007, admitted with falciparum malaria (16% parasitaemia) more than 1 month post transfusion.

Donor of Nigerian origin in USA since 2001 with no travel in the intervening period. Hospitalized with fever presumed malaria in 1988

Serology positive

6 years

MMWR USA [40]

Case 1: 27-years-old male with fever 3 weeks post blood transfusion. No travel outside Florida

27-years-old old donor of Nigerian origin in USA since 2004 with no travel in the intervening period. History of malaria 15 years previously

Serology (IFA) positive, PCR negative

5 years

Case 2: 78-years-old male receiving chemotherapy for lung carcinoma diagnosed with falciparum malaria after anaemia investigated. Several blood transfusions in previous 10 months, most recent 2–4 weeks previously. No travel in the last year.

30-years-old female, lived in East Africa as a child and travelled to Uganda, China, Brazil 13–17 months before donating

PCR negative, Serology (IFA) positive

13-17 months

MMWR USA [41]

55-years-old female; cardiac surgery and blood transfusion. Re-admitted 1 month later with falciparum malaria (microscopy and PCR positive). No recent relevant travel.

21-years-old male, born in Russia, lived in Benin for 17 years before immigrating to USA. No travel to endemic area in past 4 years

Slide and RDT neg, Serology and PCR positive (and PCR matched recipient P.F)

4 years

Lefavour et al., USA [42]

27-years-old Ghanaian female, living in USA since 1972 with end stage renal failure. Developed post-transplant falciparum malaria 2 weeks after receiving live related transplant from her mother. Treated, rejected kidney, graft nephrectomy. Second transplant a year later (cadaveric). Post transplant falciparum malaria 5 months later.

Donor 1 (mother)- from Ghana

Donor 1 (mother): serology positive

23 months

Donor 2: no information

Donor 2: serology negative