Occupational Plasmodium falciparum malaria following accidental blood exposure: A case, published reports and considerations for post-exposure prophylaxis

Abstract

A French nurse presented Plasmodium falciparum malaria 10 d after a needlestick while sampling blood in a source patient with malaria. As did the source patient, the nurse recovered fully although diagnosis was delayed and her malaria severe. We proceeded to a thorough description of the transmittal profile of P. falciparum following occupational needlestick. A review of the literature found 21 published reports of occupational malaria including our own, documenting 22 P. falciparum infections. One of these was lethal. The mean incubation time to fever inset was documented in 21 reports including our own and is 11.60±3.38 d (median 12.0, range 7-17 d). The incubation period was comparable to that found in experimental anopheline bites or transfusion malaria. The transmission profile cites a pathogen which may be more easily transmissable by occupational exposure to blood than human immunodeficiency virus (HIV) or hepatitis C virus (HCV). Undiagnosed malaria in non-immune health care workers can be lethal. Presumptive treatment of malaria is widely available and well tolerated. Clinicians should consider P. falciparum malaria when faced with a febrile patient who has or may been exposed to biological fluids. Further research is needed in the field of P. falciparum prophylaxis following accidental exposure to a malaria patient's blood.