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A Suspect Nosocomial Malaria Case, Riyadh City, March 1997.


A 14-month-old girl developed malaria while in Riyadh city, a non-malarious region. She had recently been discharged from hospital A with bronchial asthma.


We interviewed the asthmatic child's mother about history of travel and history of malaria in other family members, neighbors or visitors. We reviewed heparin preparation and administration, intravenous devices procedures, and medication rounds. We reviewed the medical files of this patient and of other malaria patients during the asthmatic patient's admission. We examined used syringes to assess the frequency of blood contamination. We reviewed malaria reports at the Riyadh health directorate for any other locally acquired malaria cases. We presented the findings to the pediatric medical and nursing staff of the hospital.


On March 1, the asthmatic girl was admitted with an acute bronchial asthma attack and pneumonia. She did not receive a blood transfusion or other blood products. She was discharged on March 6 in good condition. On March 18, she was evaluated at the same hospital for fever and a thin blood smear for WBC differential showed Plasmodium falciparum. History was not supportive of malaria exposure. On March 4, during the girl's initial hospital admission, three P. falciparum patients were admitted to the same ward and occupied three adjacent rooms. A common heparin container was the only possible medium. This was supported by an independent observation from a pediatrician in that department. The nozzles of syringes used to administer heparin became contaminated with blood most often after starting an IV line (28%). Sixty-eight cases of malaria were reported to Riyadh health directorate during February and March 1997. Of these 68 cases, 66 were imported to Riyadh from malarious areas inside and outside the kingdom.


Infected erythrocytes were most likely transferred via the heparin container and the heparin syringes. Nosocomial bloodborne transmission of malaria and other bloodborne agents is probably a common but frequently missed entity. The report of one malaria case in a person who had not traveled from malaria-free regions requires a full investigation.