Transfusion-transmitted Plasmodium vivax malaria in a hemodialysis patient in non-endemic area: A case report.

Transfusion-transmitted malaria (TTM) is a rare but potentially serious problem particularly in non-endemic areas. Detecting asymptomatic parasitemia is a challenge for current screening strategies, especially in countries with heterogeneous malaria endemicity such as Indonesia. We report a case of probable TTM due to Plasmodium vivax in a 75-year-old woman with end-stage renal disease (ESRD) undergoing regular hemodialysis in a non-endemic city, presented with a one-week history of intermittent fever, chills, myalgia, and generalized weakness, without any recent travel to malaria-endemic areas. She had received a packed red cell transfusion approximately 20 days prior to symptom onset. Peripheral blood smear demonstrated P. vivax trophozoites, confirmed by thick and thin smear microscopy. Donor tracing identified a blood donor with a history of repeated malaria vivax episodes during prior deployment in an endemic region, suggesting asymptomatic parasitemia as the likely source of transmission. This case highlights the diagnostic challenge of malaria in non-endemic areas, particularly in patients with comorbidities that may obscure the typical manifestation. It also underscores the limitations of donor screening strategies currently implemented in Indonesia.