Multiple splenic infarcts in acute Plasmodium vivax malaria:A rare case report

In tropical countries like India,malaria has been one of the most common parasitic illnesses leading to frequent hospitalization and causing major economic burden among the masses. Although Plasmodium vivax infection is considered to be benign,in contrast to Plasmodium, falciparum infection which is notorious for its severe splenic complications can occur frequently. Splenomegaly tends not to receive special attention,as it is not usually accompanied by any symptoms and can be gradually resolved via standard antimalarial therapy.Splenic infarction, although rarely attributable to malaria in an endemic region with high parasitemia,can be a rare presentation of this disease entity.

Plasmodium vivax cerebral malaria complicated with venous sinus thrombosis in Colombia

Complicated malaria is usually due to Plasmodium falciparum.Nevertheless,Plasmodium vivax is infrequently related with life-threatening complications.Few cases have been reported of severe Plasmodium vivax infection,and most of them from Southeast Asia and India.We report the first case of cerebral malaria due to Plasmodium vivax in Latin America,complicated with sagittal sinus thrombosis and confirmed by a molecular method.

A case of hemophagocytic syndrome as a complication of <i>Plasmodium</i>vivax malaria

Hemophagocytic lymphohistiocytosis syndrome (HPS) is a potentially fatal hyperinflammatory response characterized by a generalized histiocytic proliferation with marked hemophagocytosis in bone marrow [1]. Hemophagocytic syndrome has been associated with genetic mutations, autoimmune diseases, hematological malignancies or infections [2,3]. According to the data from Centre for Disease Control and prevention (CDC) Plasmodium falciparum has been associated with HPS but not the Plasmodium vivax [4-7]. We report a case of hemophagocytic syndrome as a complication of Plasmodium vivax malaria which is a rare presentation according to the data. This patient presented with high grade fever with chills (P. vivax positive), fever however did not respond to anti-malarials. The patient continued to have high grade fever with altered sensorium and deranged liver function with pancytopenia. Since she fulfilled the criteria of (HPS), patient was put on injectable steroids and responded dramatically. Hemophagocytic syndrome is a potentially fatal syndrome and therefore high index suspicion and early treatment is the key to reduce the mortatlity.

Spectrum of complications associated with Plasmodium vivax infection in a tertiary hospital in South-Western India

Objective:To determine the range and incidence of complications associated with Plasmodium vivax[P.vivax) malaria.Methods:A retrospective analysis was performed of all patients of P.vivax malaria admitted in kasturba Medical College.Manipal between January and December,2010.Patients with mixed malarial infection were excluded by appropriate tests. Clinical presentation and laboratory parameters were studied.Results:Medical records of 213 individuals who satisfied the inclusion criteria were reviewed.Anaemia was seen in 65 (30.5%),leucopenia in 38(17.8%]and thrombocytopenia in 184(86.4%l patients.Aspartate and alanine aminotransferases were elevated in 86(40.4%).and 89(41.9%) patients respectively. Hypoalbuminemia was observed in 157(73.6%) cases.Elevated serum creatinine was noted in in 59(27.5%) patients.Creatine kinase was elevated in 30 nut of 59 patients(50.8%).Overall.107 (50.2%) patients fulfilled WHO criteria for sever=e malaria.None of the patients succumbed to the disease.Conclusion:P.vivax malaria is a potentially severe disease,and the term ’ benign" tertian malaria is a misnomer.Despite significant morbidity,with timely and appropriate treatment P.rirax malaria has an excellent outcome.

A study on the clinical profile of complicated Plasmodium vivax mono-infections

Objective:To identify cases of severe Plasmodium vivax(P.vivax) mono-infections among adults.Methods:In this retrospective study,30 adult patients admitted to medical wards of a tertiary hospital in a malaria endemic urban area from March 2010 to April 2010 were included. The diagnosis of P.vivax malaria was established by peripheral blood film(PBF) examination, and severe malaria was categorized as per World Health Organization guidelines.Results: Complications observed were thrombocytopenia in 28(93.3%),hepatic dysfunction and jaundice in 13(433%),renal dysfunction in 8(26.7%),severe anaemia in 3(10.0%),cerebral malaria in 2 (6.7%),and acute respiratory distress syndrome(ARDS) in 1(3.3%) of 30 patients.Conclusions:P. vivax malaria with severe complications is common in the investigated area,and an intensive and large-scale study of the disease is necessary.

Vivax malaria:a rare cause of thalamic bleed

Most common cause of thalamic bleed is hypertension;other causes are arteriovenous malformation,aneurysm,bleeding thathesis,drugs,amyloid angiopathy,tumor etc.We present a case of Plasmodium vivax(P.vivax) malaria with unusual site of bleeding i.e.left thalamus of brain.To the best of our knowledge,this is the first reported case of thalamic bleed caused by vivax malaria in absence of severe thrombocytopenia/disseminated intravascular coagulation (DIC).

上林县输入性间日疟和卵形疟与G6PD缺乏患者流行病学调查研究

目的统计分析上林县输入性间日疟和卵形疟与葡萄糖-6-磷酸脱氢酶(G6PD)缺乏患者流行病学特征,为疟疾防治提供科学依据。方法收集上林县人民医院2017年6月18日至2023年3月29日入院治疗输入性疟疾患者的数据进行整理分析。结果收治输入性疟疾患者共578例,其中恶性疟患者占40.48%(234/578),需要伯氨喹进行根治的间日疟、卵形疟及混合感染患者占37.54%(217/578);其中G6PD缺乏患者占10.90%(63/578),需根治的G6PD缺乏患者占9.68%(21/217)。结论上林县需要根治的输入性间日疟和卵形疟患者较多,特别是对G6PD缺乏又需根治的患者应加强管理,预防二代病例的出现。

Prevalence of malaria infection in Sarbaz,Sistan and Bluchistan province

Objective:To survey malaria prevalence in Sarbaz from April 2009 to October 2010.Methods: Epidemiological data of 1 464 confirmed malarial patients were analyzed according to demographic status,sex,age,nationality,isolated species and residence place.Results:The majority of patients were male 930(64.8%) but 514(35.2%) were female.82.5%of patients were Iranian,14%Pakistani immigrants,and 3.5%Afghan immigrants.Data collected showed that 90% of isolated species were Plasmodium vivax,7.8%Plasmodium falciparum,and 2.2%Plasmodium malariae and mixed species.Conclusions:Therefore,it is crystal clear that refugees should be prohibited by government and controlled by experts in health centers in order to campaign effectively with this life threating disease.

Possible role of PGD_2 in malaria infections

Objective:To preliminarily investigate the possible role of prostaglandin D_2(PGD_2) in malaria infections.Methods:Blood and urinary samples(n=120 each) were collected from Thai patients with Plasmodium falciparum(P.falciparum) with moderate(n=26) and high(n=4) parasitemia,patients with Plasmodium vivax(P.vivax)(n=30),patients with fever associated with other infections(n=30),and healthy subjects(n=30).PGD_2 concentrations in plasma and urinary samples of healthy subjects,patients with fever associated with other infections and patients with malaria were determined using Prostaglandin D2-MOX express EIA kit(Cayman Chemical,USA).Results:The possible association between PGD_2 and malaria infections is clearly demonstrated with PGD_2 concentration in urine.The urinary PGD_2 concentrations were relatively high(about 5-fold) in patients with P.falciparum with moderate parasitemia and P.vivax infections compared with other groups.Furthermore,the concentration in patients with P.falciparum with moderate parasitemia and P.vivax infection were significantly higher than that in healthy subjects and patients with fever associated with other infections.Conclusions:Urinary PGD_2 concentrations may offer a more dependable and useful tool for predicting malaria severity.Confirmation is this preliminary finding is required with a larger sample size.

Clinical features of severe malaria:Protective effect of mixed plasmodial malaria

Objective: To investigate clinically severe malaria patients with Plasmodium falciparum(P. falciparum), Plasmodium vivax(P. vivax) and mixed species infections.Methods: This study was conducted at Dr. Saiful Anwar General Hospital, Malang,Indonesia, from December 2011 to May 2013. Twenty nine patients(mean age of 41 years, 22% female), who suffered from severe malaria according to World Health Organization criteria(major and minor) and other criteria based on previous studies, were selected by consecutive sampling. Blood samples were obtained at admission from peripheral blood for microscopic diagnostic, nested PCR and laboratory examination of blood chemistry. Laboratory results were compared between the groups and correlated to each other.Results: From 29 samples, eight(28%) were diagnosed as P. falciparum mono-infection,12(41%) as P. vivax mono-infection and nine(31%) as mixed infections, confirmed by PCR. Cerebral malaria occurred in P. falciparum or mixed species infection only. Parasitaemia was highest in P. falciparum mono-infection. Mean haemoglobin was significantly lower in P. falciparum than P. vivax infection(P = 0.01). Mean thrombocyte count(77 138/m L) was low in all groups. Mean urea, creatinine, total and direct bilirubin were significantly higher in P. falciparum mono-infection compared to other groups, whereas aspartate aminotransferase and alanine aminotransferase showed no significant differences. Parasitaemia was positively correlated with an increase in urea, creatinine, bilirubin and leucocytosis in all species.Conclusions: Both Plasmodium species can solely or in combination cause severe malaria. Mixed infection was generally more benign than P. falciparum mono-infection and seemed to have some protective effects.

A case of misdiagnose of malaria infection

A case of malaria infection in a 42-year-old woman in rural area of Mahmodabad,Mazandaran Province,North Iran was reported and discussed elaborately.She was complaining about recurrent fevers,sweating,headache and myalgia in back.After her first admission to hospital due lo misdiagnose she did not receive proper treatment and the patient suffered from clinical manifestations again.Eventually in the second admission to another hospital,after a precise examination on her thick and thin blood smear the agent of disease was recognized appropriately as Plasmodium vivax and treated accordingly.

Congenital Malaria: First Case Report in Kuwait

Background: Malaria in pregnancy poses a great health risk to the mother and her fetus and causes abortion, stillbirth, intrauterine growth retardation and low birth weight. The symptoms commonly start between 10 - 30 days of age and the symptoms mostly observed are fever, restlessness, drowsiness, jaundice, poor feeding, vomiting, diarrhea, and hepatosplenomegaly. Aim: The aim of this study was to diagnose malaria in a neonate admitted to ICU with fever, jaundice and hepatomegaly. Case Summary: A 32-day-old female child was admitted to ICU for intermittent high grade fever and rapid breathing, pallor, poor feeding, mild hepatosplenomegaly and physiological jaundice of one-week duration. The mother had malaria two years before while visiting her native country, Afghanistan and was treated with chloroquine for three days. Conclusion: High suspicion should be considered in diagnosing malaria during pregnancy to prevent congenital malaria among all neonates who present fever and splenomegaly in malaria endemic areas as well as in women from malaria endemic countries living in non-endemic areas. In this report, we describe the first case of congenital malaria in a child in non-malaria endemic Kuwait.

疟疾胶体金免疫层析试条在间日疟流行区的诊断评价

目的在现场评价疟疾胶体金免疫层析试条(简称试条)的诊断性能。方法2008年9～10月采集安徽省间日疟流行区蒙城县5个乡镇医院门诊部所有就诊的发热病人血样,用双盲法比较镜检法和试条测试的结果。结果共采集发热病人血样292份,镜检法检出疟原虫阳性181份,均为间日疟;试条检出疟原虫阳性163份,亦均为间日疟。两法检测结果一致的血样占92.8%(271/292),其中均为阳性的163份,均为阴性的108份。两法检测结果不一致的21份血样中,镜检阳性的、试条检测阴性的有18份,镜检阴性的、试条检测阳性的有3份。原虫密度在>1000个/μl、100～1000个/μl和<100个/μl时,试条检测阳性率分别为93.5%(115/123)、86.0%(43/50)和62.5%(5/8)。结论该快速诊断疟疾胶体金免疫层析试条在疟疾流行区对间日疟有一定的诊断价值。

标签引物-套式/多重PCR检测恶性疟原虫和间日疟原虫的研究

目的建立简便、灵敏、低本底、可同时检测恶性疟原虫和间日疟原虫的套式/多重聚合酶链反应(PCR)系统。方法应用标签引物扩增技术、PrimerPremier5.0软件、美国生物信息中心(NCBI-BLAST)网络资源和矩阵试验法优化套式/多重PCR,检测疟疾患者滤纸血样并与镜检结果进行比较。结果新建立的标签引物套式/多重PCR,检测模拟现场滤纸血样的敏感性为恶性疟原虫1～2个虫/μl血,间日疟原虫5～10个虫/μl血。检测71份现场采集的镜检疟原虫阳性滤纸血样(恶性疟24份和间日疟47份)的结果与镜检结果的符合率分别为87.5%和100%。结论通过标签引物扩增技术优化的套式/多重PCR系统,适用于检测现场采集的滤纸血样,其检出低原虫血症的敏感性和鉴定虫种的准确性均优于镜检法,是很有潜力的疟疾诊断技术。

复方萘酚喹治疗间日疟的疗效观察

目的 :观察复方萘酚喹与氯喹治疗间日疟的临床疗效。方法 :以显微镜血检单纯间日疟原虫阳性患者为观察对象 ,药物为复方萘酚喹 (萘酚喹 40 0mg 青蒿素 1 0 0 0mg) ,1次顿服 ,服药后按时测量体温和血检原虫 ,随访 42天 ,观察治疗效果。结果 :复方萘酚喹治疗 1 0 9例 ,平均退热时间为 ( 1 3 0± 5 5 )h ,原虫转阴时间为 ( 1 8 1± 5 7)h,治愈率为 1 0 0 %。药后无明显不良反应。结论 :复方萘酚喹治疗间日疟具有良好的效果。

套式／多重PCR方法应用于疟疾诊断与监测的初步评价

目的与镜检法比较评价标签引物-套式/多重PCR(UT-PCR)在疟疾监测中的应用价值。方法在海南、云南省恶性疟和间日疟混合流行区和广西疟疾控制区的疟疾监测中,采集初诊为疟疾或疑似疟疾的发热患者的血片与滤纸血样400份,在双盲条件下比较镜检法与UT-PCR的初检结果,对结果不一致的血片再次镜检复查,同时对其滤纸血样重复PCR2～3次;评估UT-PCR与镜检法的敏感性和特异性。结果400例发热患者血样中,镜检法初检检出疟原虫阳性234例,其中恶性疟125例,间日疟109例;UT-PCR检出疟原虫阳性235例,其中恶性疟124例,间日疟109例;恶性疟和间日疟混合感染2例。两法初检结果一致的血样占92.5%(370/400),其中阴性154例,阳性216例(间日疟117例,恶性疟99例)。复查25份初检结果不一致的血样,包括镜检阴性PCR阳性11例,镜检阳性PCR阴性10例,镜检为恶性疟PCR为间日疟3例,镜检为间日疟而PCR为混合感染1例,其中15份与UT-PCR的初检结果一致,7份"假阳性"原因不明,仅3份为PCR的假阴性。根据复查结果评估PCR的敏感性为99.6%,特异性为98.8%。结论采用更敏感的UT-PCR疟疾诊断方法有助于解决疟疾诊断与鉴别诊断中的疑难问题,提高疟疾监测的质量和效率。

阿奇霉素治疗间日型猴疟效果的研究

目的探讨阿奇霉素对疟原虫的杀灭作用及对疟原虫复燃的影响。方法健康和免疫缺陷的恒河猴(体重5 kg)各1只,血传感染食蟹猴疟原虫,待血液中疟原虫密度分别到达2 266.67个/μl和3 796.08个/μl时,每只猴每天口服阿奇霉素500 mg,健康猴和免疫缺陷猴分别连续服药12和19 d。每天采血镜检观察。结果健康猴感染后11 d,免疫缺陷猴感染后17 d血中疟原虫消失。两只猴连续7个月血检疟原虫均为阴性。结论单服阿奇霉素对间日型猴疟原虫具有直接杀灭作用,提示对间日型猴疟有较好的近期和远期疗效。

安徽省间日疟流行区局部疫情回升的特点分析

目的 分析安徽省疟疾局部疫情回升的特点及原因 ,为制订防制措施提供依据。 方法 对有局部疫情回升的7个县、区所有行政村摸底调查 ,了解 1998年以来的疫情动态及防治措施落实情况 ;对 2 0 0 1年 1～ 7月份的报告病例作个案调查 ,分析发病特点。 结果 新发疫点数由 1998年的 34个增加到 2 0 0 1年的 2 49个 ,其中重疫点数由 2个增加到6 0个 ,发病率≥ 5‰的疫点由 0个增加到 3个 ;2 0 0 1年 1～ 7月份的 72 7例病人中 ,2 0岁以下者占 5 4.2 % ,无疟史新感染者占 89.3% ( 6 2 8/ 70 3)。 结论 新疫点、重疫点数逐年增多 ,年青的新病例占多数 ,疫情回升明显。

疟疾病人血液检验有关指标的变化和诊断价值

目的探讨常规检验项目RBC、Hb、WBC、PLT计数、红细胞体积分布宽度(RDW)和血清总胆固醇(TCH)变化及其在疟疾诊断中的价值。方法研究包括40名确诊的疟疾病人和40名配对的健康对照者,用血球分析仪和生化分析仪分别检测RBC、Hb、WBC、PLT和TCH。结果RBC、Hb、PLT计数和TCH显著低于对照组,在疟疾组存在贫血和血小板减低血症。结论RBC降低、Hb降低、TCH降低特别是PLT计数降低是协助诊断疟疾的有用指标。

间日疟患者外周血NKγδ T Treg细胞含量的变化

目的分析间日疟原虫现症感染者外周血中NK、γδ T细胞、CD4+CD25+T淋巴细胞及其FOXP3的表达情况,以初步了解患者的一些细胞免疫特性。方法用流式细胞仪检测25例间日疟原虫现症感染者(AC)、13例免疫对照者(IC)及14例正常对照者(NC)外周血中NK、γδT细胞和CD4+CD25+T淋巴细胞的百分含量,同时观察CD4+CD25+T细胞中表达FOXP3群体的百分含量。结果AC组外周血NK细胞百分含量为8.48%,与NC组(15.53%)及IC组(17.69%)比较,明显降低(P均<0.05);AC组外周血γδ T细胞、CD4+CD25+T细胞百分含量分别为4.32%和5.42%,较NC组(2.55%和3.94%)及IC组(2.70%和3.44%)明显升高(P均<0.05);AC组外周血CD4+CD25+T淋巴细胞中表达FOXP3的细胞数量为8.14%,低于NC组的11.09%及IC组的11.32%,但差异无统计学意义(P>0.05)。结论间日疟原虫急性感染期患者外周血NK细胞数量减少,但γδ T淋巴细胞增加;CD4+CD25+T淋巴细胞中表达FOXP3群体的细胞稍有降低。