Diagnostic challenges of prolonged post-treatment clearance of Plasmodium nucleic acids in a pre-transplant autosplenectomized patient with sickle cell disease.

BACKGROUND: Autosplenectomy, as a result of sickle cell disease, is an important risk factor for severe malaria. While molecular methods are helpful in providing rapid and accurate infection detection and species identification, the effect of hyposplenism on result interpretation during the course of infection should be carefully considered. CASE PRESENTATION: A 32-year old autosplenectomized Nigerian male with severe sickle cell disease was referred to the National Institutes of Health for allogenic hematopoietic stem cell transplant. Despite testing negative for malaria by both smear and PCR 2 weeks after arrival in the USA, the patient developed fever and diffuse bilateral lower rib cage and upper abdominal pain 2 weeks later and subsequently tested positive for Plasmodium falciparum. Parasitaemia was tracked over time by microscopy and nucleic acid tests to evaluate the therapeutic response in the setting of hyposplenism. The patient showed prompt resolution of patent infection by microscopy but remained positive by molecular methods for > 30 days after treatment initiation. CONCLUSION: While molecular testing can provide sensitive Plasmodium nucleic acid detection, the persistence of Plasmodium nucleic acids following adequate treatment in functionally asplenic patients can lead to a diagnostic dilemma. In such patients, clinical response and peripheral blood smears should guide patient management following treatment. Nonetheless, in pre-transplant patients at high-risk for pre-existing Plasmodium infections, highly sensitive molecular assays can be useful to rule out infection prior to transplantation.

Prevalence of hypermucoid Klebsiella pneumoniae among wild-caught and captive vervet monkeys (Chlorocebus aethiops sabaeus) on the island of St. Kitts.

Invasive, hypermucoid Klebsiella pneumoniae causes severe abscess formation in humans and in certain species of nonhuman primates. We conducted a survey of captive and wild-caught African green monkeys, or vervets (Chlorocebus aethiops sabaeus), on the Caribbean island of St. Kitts to assess their carriage rate of Klebsiella spp. Forty percent of rectal swabs from captive monkeys were positive for K. pneumoniae, and 20% of wild-caught animals were positive. Two wild-caught monkeys (4%) were positive for K. oxytoca, and one monkey (2%) was found to be infected with a hypermucoid rmpA-positive K. pneumoniae strain. Genotyping of this strain showed that it had an indistinguishable random amplified polymorphic DNA fingerprint to a strain that caused fatal abscessation in several African green monkeys in a research colony in the USA in 2005. This is the first report of hypermucoid K. pneumoniae isolation from a wild population of nonhuman primates and represents a potential health risk to these animals, as well as to the humans who come in contact with them.