Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report
| Autor: | Jessie Hiu, Patricia Adem, Balbir Singh, Sherif R. Zaki, Sebastian Lucas, Paul C. S. Divis, Janet Cox-Singh, Kum Thong Wong, Mohammad Zulkarnaen, Patricia Ann Chandran, Sanjeev Krishna |
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| Přispěvatelé: | University of St Andrews. School of Medicine, University of St Andrews. Infection Group, University of St Andrews. Biomedical Sciences Research Complex |
| Rok vydání: | 2010 |
| Předmět: |
Male
Pathology ARDS Dengue virus Kidney medicine.disease_cause Polymerase Chain Reaction Dengue fever Fatal Outcome 0302 clinical medicine Borneo Eosinophilic Lung 0303 health sciences Brain 3. Good health Blood Infectious Diseases medicine.anatomical_structure Liver RB Pathology Plasmodium knowlesi Adult medicine.medical_specialty lcsh:Arctic medicine. Tropical medicine lcsh:RC955-962 030231 tropical medicine Spleen Biology lcsh:Infectious and parasitic diseases 03 medical and health sciences SDG 3 - Good Health and Well-being Case report parasitic diseases medicine Animals Humans lcsh:RC109-216 Acute tubular necrosis 030304 developmental biology medicine.disease biology.organism_classification Malaria Immunology Parasitology RB Endocardium |
| Zdroj: | Malaria Journal Malaria Journal, Vol 9, Iss 1, p 10 (2010) |
| ISSN: | 1475-2875 |
| Popis: | Background Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. Case presentation A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. Conclusions The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria will aid the interpretation of, often conflicting, information on malaria pathophysiology in humans. |
| Databáze: | OpenAIRE |
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