Nosocomial malaria and saline flush

Abstract

An investigation of malaria in a US patient without recent travel established Plasmodium falciparum molecular genotype identity in 2 patients who shared a hospital room. P. falciparum can be transmitted in a hospital environment from patient to patient by blood inoculum if standard precautions are breached.

Figure 1

Mass spectroscopic analysis of sterile saline flush syringes after routine use. The contents of the used syringes were concentrated by centrifugation. Matrix-assisted laser desorption ionization detected the α and β chains of hemoglobin as the ions at mass/charge (m/z) 15,126 and 15,867, respectively, in samples A (red), B (green), C (blue), and J (aqua) that were absent in the matrix alone (black). The lower limit of sensitivity with matrix-assisted laser desorption ionization is ≈0.5 erythrocytes per mL.

Figure 2

Genotype analysis of patient blood films. Restriction fragment length polymorphism are shown for Pfmsp2 and Pfcrt. Patient 1 and 2 are identical at the polymorphic Pfmsp2 (lanes 1 and 2), while unrelated patient controls (lanes 3 and 4) are different. One of the 2 negative controls is shown (lane 5). Genomic DNA from clone HB3 (lane 6) and isolate NF54 (lane 7) are also included as additional positive controls. All recent patient samples have the Plasmodium falciparum chloroquine-resistant genotype.

Figure A1

Capillary electropherograms of Plasmodium microsatellite analysis. The x axis represents fragment size in bases and the y axis represents fluorescence intensity. The P. falciparum microsatellites products C13M30 and PFPK (black peaks) and TA81 and C4M8 (blue peaks) from amplification genomic DNA from patients 1, 2, one of the unrelated patient controls, and control P. falciparum clone HB3. Each microsatellite has ≥10 alleles. Patients 1 and 2 have identical microsatellites at all 4 loci (Table).