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Louvois M, Simon L, Pomares C, Jeandel PY, Demonchy E, Carles M, Delaunay P, Courjon J. Case Report: Autoimmune Hemolysis Anemia After Dihydroartemisinin and Piperaquine for Uncomplicated Plasmodium falciparum Malaria. Front Med (Lausanne) 2022; 8:756050. [PMID: 35111773 PMCID: PMC8801417 DOI: 10.3389/fmed.2021.756050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria is still an endemic disease in Africa, with many imported cases in Europe. The standard treatment is intravenous artesunate for severe malaria and oral artemisinin-based combination therapy (ACT) for uncomplicated malaria. Delayed hemolytic anemia (DHA) after intravenous artesunate has been extensively described, and guidelines recommend biological monitoring until 1 month after the end of the treatment. A link with an autoimmune process is still unsure. Nevertheless, cases with positive direct antiglobulin test (DAT) have been reported. Conversely, DHA is not recognized as an adverse effect of oral ACT. Previously, only few cases of DHA occurring after oral ACT without intravenous artesunate administration have been reported. We report the case of a 42-year-old man returning from Togo. He was treated with dihydroartemisinin/piperaquine combination for uncomplicated Plasmodium falciparum malaria, with low parasitemia. Nine days after the end of the treatment, the patient developed hemolytic anemia with positive DAT. Eventually, the patient recovered after corticotherapy. After excluding common causes of autoimmune hemolytic anemia, we considered that dihydroartemisinin/piperaquine treatment was involved in this side effect.
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Affiliation(s)
- Marion Louvois
- Rheumatology, Université Côte d'Azur, CHU Nice, Nice, France
| | - Loïc Simon
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | - Christelle Pomares
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | | | - Elisa Demonchy
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
| | - Michel Carles
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
| | - Pascal Delaunay
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | - Johan Courjon
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
- *Correspondence: Johan Courjon
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Im JH, Chung MH, Lee HJ, Kwon HY, Baek JH, Jang JH, Lee JS. Splenic infarction and infectious diseases in Korea. BMC Infect Dis 2020; 20:915. [PMID: 33267828 PMCID: PMC7708890 DOI: 10.1186/s12879-020-05645-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed. Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n = 12], babesiosis [n = 1]); bacteria (scrub typhus [n = 5]); viruses (Epstein–Barr [n = 1], cytomegalovirus [n = 1]); and unidentified pathogen[s] (n = 7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.
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Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju-do, Republic of Korea
| | - Hye-Jin Lee
- Translation Research Center, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea
| | - Ji-Hun Jang
- Department of Hospital Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, 22212, Republic of Korea.
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Infarctus splénique révélant un accès palustre à Plasmodium vivax. Med Mal Infect 2020; 50:746-747. [DOI: 10.1016/j.medmal.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/12/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
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Li XZ, Song J, Sun ZX, Yang YY, Lin YQ, Wang H. Conventional Ultrasound and Contrast-Enhanced Ultrasound in the Diagnosis of Splenic Diseases: A Systematic Review and Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1687-1694. [PMID: 32323353 DOI: 10.1002/jum.15291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/21/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
Accurate diagnosis of splenic diseases is important for timely and accurate treatment. The objective of this study was to compare the accuracy of contrast-enhanced ultrasound (CEUS) and conventional ultrasound (US) in detecting splenic lesions. A systematic literature search was undertaken, and 8 studies met the inclusion criteria. The sensitivity and specificity of the consolidated results of CEUS were 0.95 (95% confidence interval [CI], 0.92-0.97) and 0.97 (95% CI, 0.90-0.99), respectively (I2 = 27.4%; area under the curve [AUC] from a summary receiver operating characteristic curve = 0.97). The sensitivity and specificity of the consolidated results of conventional US were 0.70 (95% CI, 0.56-0.80) and 0.96 (95% CI, 0.76-0.99; I2 = 83.4%; AUC = 0.84). In this systematic review and meta-analysis, the sensitivity and specificity of CEUS were higher than those of conventional US in diagnosing splenic lesions. Contrast-enhanced US is a promising method for accurately diagnosing splenic lesions.
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Affiliation(s)
- Xing-Zhao Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jun Song
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhi-Xia Sun
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan-Yan Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuan-Qiang Lin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
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Gonzalez L, Shapiro AF, Tafur A, Plaza-Meneses C, Sabando B. Splenic Infarct Secondary to High Altitude Exposure in Sickle Cell Trait Patients: A Case Series. Cureus 2020; 12:e9815. [PMID: 32821639 PMCID: PMC7431312 DOI: 10.7759/cureus.9815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The sickle cell trait is considered a benign entity that generally does not show clinical manifestations. However, some complications have been described under certain conditions, such as a decrease in oxygen level, dehydration, and strenuous physical efforts. Among them, splenic infarct is a rare complication that presents as left upper abdominal pain in a situation of stress such as high altitude exposure. We present two cases of splenic infarcts in patients with undiagnosed sickle cell trait who showed to our institution with severe abdominal pain after coming from high altitude cities.
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Affiliation(s)
- Luis Gonzalez
- Medicine, Nassau University Medical Center, East Meadow, USA
| | | | | | | | - Brenner Sabando
- Hematology, Hospital Luis Vernaza/Universidad Espíritu Santo (UEES), Guayaquil, ECU
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Kim SH, Jung HS, Park S. Serial follow-up of malaria-induced splenic infarction: A case report. Ann Hepatobiliary Pancreat Surg 2020; 24:239-242. [PMID: 32457274 PMCID: PMC7271104 DOI: 10.14701/ahbps.2020.24.2.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/25/2022] Open
Abstract
Malaria shows various clinical manifestations from mild fever to death depending on the Plasmodium species. Among the complications, reports of malaria-associated splenic infarctions are rare. Here we present a case in which a man suffered from malaria-induced splenic infarction with serial follow-up. A 28-year-old man who served in the military near the Korean Demilitarized Zone (DMZ) was referred to the emergency room for fever beginning 1 week ago. He suffered upper abdominal pain for 2 days. At the time of his visit, he experienced a fever spiking up to 39.8°C. In the patient’s computed tomography (CT) test, splenomegaly with low attenuation density suggesting splenic infarction and hepatomegaly was shown. Because red blood cells infected by a plasmodium species were shown in a peripheral blood smear, he was admitted for malaria infection. The patient was given oral chloroquine on the day of admission and on hospital day (HOD) 3, Plasmodium vivax was detected in his malaria PCR test. After conservative management, the patient’s condition improved. The patient was discharged on HOD 15 without any symptoms. At this time, the patient’s spleen size decreased to the upper limit size of normal according to an ultrasonography. After that, the patient visited the outpatient department. Although low attenuation density still appeared in the following CT on HOD 30, a subsequent ultrasonography on HOD 60 did not show any specific finding. Although malaria-induced splenic infarction is still rare, this rate may increase. Most of the cases can be treated without surgery.
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Affiliation(s)
- Sung Hyun Kim
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Hong Sung Jung
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sejin Park
- Department of Surgery, Armed Forces Capital Hospital, Seongnam, Korea
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Li Y, George A, Arnaout S, Wang JP, Abraham GM. Splenic Infarction: An Under-recognized Complication of Infectious Mononucleosis? Open Forum Infect Dis 2018; 5:ofy041. [PMID: 29577060 PMCID: PMC5853003 DOI: 10.1093/ofid/ofy041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/14/2018] [Indexed: 11/26/2022] Open
Abstract
Splenic infarction is a rare complication of infectious mononucleosis. We describe 3 cases of splenic infarction attributed to infectious mononucleosis that we encountered within a 2-month period. We underscore the awareness of this potential complication of infectious mononucleosis and discuss the differential diagnosis of splenic infarction, including infectious etiologies. While symptomatic management is usually sufficient for infectious mononucleosis-associated splenic infarction, close monitoring for other complications, including splenic rupture, is mandated.
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Affiliation(s)
- Yan Li
- Saint Vincent Hospital, Worcester, Massachusetts
| | - Ann George
- Saint Vincent Hospital, Worcester, Massachusetts
| | - Sami Arnaout
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer P Wang
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - George M Abraham
- Saint Vincent Hospital, Worcester, Massachusetts.,University of Massachusetts Medical School, Worcester, Massachusetts
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Mechanism of splenic cell death and host mortality in a Plasmodium yoelii malaria model. Sci Rep 2017; 7:10438. [PMID: 28874800 PMCID: PMC5585408 DOI: 10.1038/s41598-017-10776-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/14/2017] [Indexed: 12/14/2022] Open
Abstract
Malaria is a fatal disease that displays a spectrum of symptoms and severity, which are determined by complex host-parasite interactions. It has been difficult to study the effects of parasite strains on disease severity in human infections, but the mechanisms leading to specific disease phenotypes can be investigated using strains of rodent malaria parasites that cause different disease symptoms in inbred mice. Using a unique mouse malaria model, here we investigated the mechanisms of splenic cell death and their relationship to control of parasitemia and host mortality. C57BL/6 mice infected with Plasmodium yoelii nigeriensis N67C display high levels of pro-inflammatory cytokines and chemokines (IL-6, IFN-γ, TNF-α, CXCL1, and CCL2) and extensive splenic damage with dramatic reduction of splenic cell populations. These disease phenotypes were rescued in RAG2−/−, IFN-γ−/−, or T cell depleted mice, suggesting IFN-γ and T cell mediated disease mechanisms. Additionally, apoptosis was one of the major pathways involved in splenic cell death, which coincides with the peaks of pro-inflammatory cytokines. Our results demonstrate the critical roles of T cells and IFN-γ in mediating splenic cell apoptosis, parasitemia control, and host lethality and thus may provide important insights for preventing/reducing morbidity associated with severe malaria in humans.
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