Sub-acute intestinal obstruction - a rare complication of Plasmodium falciparum malaria in an adult: a case report

Oral administration of IPI549 protects mice from neuropathology and an overwhelming inflammatory response during experimental cerebral malaria

Infection with Plasmodium falciparum is often deadly when it results in cerebral malaria, which is associated with neuropathology described as an overwhelming inflammatory response and mechanical obstruction of cerebral microvascular. PI3Kγ is a critical component of intracellular signal transduction and plays a central role in regulating cell chemotaxis, migration, and activation. The purpose of this study was to examine the relationship between inhibiting the PI3Kγ pathway and the outcome of experimental cerebral malaria (ECM) in C57BL/6J mice infected with the mouse malaria parasite, Plasmodium berghei ANKA. We observed that oral administration of the PI3Kγ inhibitor IPI549 after infection completely protected mice from ECM. IPI549 treatment significantly dampened the magnitude of inflammatory responses, with reduced production of pro-inflammatory factors, decreased T cell activation, and altered differentiation of antigen-presenting cells. IPI549 treatment protected the infected mice from neuropathology, as assessed by an observed reduction of pathogenic T cells in the brain. Treating the infected mice with IPI549 three days after parasite inoculation improved the murine blood brain barrier (BBB) integrity and helped the mice pass the onset of ECM. Together, these data indicate that oral administration of the PI3Kγ inhibitor IPI549 has a suppressive role in host inflammation and alleviates cerebral pathology, which supports IPI549 as a new malaria treatment option with potential therapeutic implications for cerebral malaria.

Silent Bowels From a Silent Bite: A Rare Case of Paralytic Ileus Complicating Plasmodium falciparum Infection

Malaria is a life-threatening, parasitic disease that continues to infect millions of people, especially in endemic regions. Despite advancements in malaria treatment, treating the disease remains challenging. One major challenge is identifying the disease from its unconventional manifestations. Therefore, recognizing its unusual clinical presentations is imperative in early detection and management with a better prognosis. This case report highlights the unique finding of paralytic ileus from a patient with confirmed malaria. Further investigation on the concurrence between paralytic ileus and malaria may aid in identifying the disease and subsequent improvement in treatment.

Acute Colonic Pseudo-Obstruction in Severe Falciparum Malaria: A Case Report

Severe falciparum malaria is associated with multiple organ dysfunctions. The most manifestations of severe falciparum malaria are cerebral malaria, acute lung injury, and acute kidney injury. Acute colonic pseudo-obstruction is extremely rare. Early recognition and management are essential because a delay in diagnosis is associated with substantial morbidity and mortality. A 29-year-old peacekeeper in the Democratic Republic of Congo (DRC) was diagnosed as severe falciparum malaria with high-grade fever, jaundice, electrolyte disturbance, and thrombocytopenia. Although adequate antimalaria therapy with intramuscular artemether was given, the patient had persistent fever, shallow and fast breathing, and abdominal pain. Investigations suggested a diagnosis of acute colonic pseudo-obstruction. Antimalarial therapy was continued with intravenous artesunate. And rectal decompression and fasting were taken. Soon, symptoms of colonic obstruction mitigated. And the patient was cured and discharged. Acute colonic pseudo-obstruction should be considered for severe malaria patients with abdominal distention and pain. The early diagnosis and proper management of the patient with severe malaria complicated with acute colonic pseudo-obstruction are the keys to a good prognosis.

Does Malaria Cause Diarrhoea? A Systematic Review

Malaria is a systemic febrile disease that may progress to prostration, respiratory distress, encephalopathy, anemia, and death. Malaria is also an established risk factor for invasive bacterial disease caused, in the majority of cases, by invasive enteropathogens and in particular by non-Typhoidal Salmonella (NTS). Whilst various malaria-related pathologies have been implicated in the risk of NTS bacteraemia in animal models, including intestinal dysbiosis and loss of gut homeostasis, clinical evidence is lacking. As a first step in gathering such evidence, we conducted a systematic review of clinical and epidemiological studies reporting the prevalence of diarrhoea among malaria cases and vice versa. Database searches for "plasmodium" and "diarrhoea" identified 1,771 articles; a search for "plasmodium" and "gastroenteritis" identified a further 215 articles. After review, 66 articles specified an association between the search terms and referred primarily, but not exclusively, to Plasmodium falciparum infections. Overall, between 1.6 and 44% of patients with acute malaria infection reported symptoms of diarrhoea (812 of 7,267 individuals, 11%) whereas 5-42% of patients presenting to hospital with diarrhoea had an underlying malaria parasite infection (totaling 749 of 2,937 individuals, 26%). However, given the broad range of estimates, a paucity of purposeful case control or longitudinal studies, and varied or poorly specified definitions of diarrhoea, the literature provides limited evidence to draw any firm conclusions. The relationship between malaria and gastrointestinal disturbance thus remains unclear. Carefully designed case-control studies and prospective longitudinal studies are required to confidently assess the prevalence and significance of intestinal manifestations of malaria parasite infection.

A case of Falciparum malaria presenting with features of functional bowel obstruction

Malaria is the most common tropical disease in Sudan, which is caused by an infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Headache, fever, cough, fatigue, malaise, shaking chills, arthralgia and myalgia are the cardinal features of malaria, but occasionally, it has an atypical presentation. Intestinal obstruction as a complication is an extremely rare presentation. Here within, we describe a 28-year-old Sudanese man who has presented with of colicky abdominal pain, absolute constipation for two days and fever. Blood film for malaria was positive for Plasmodium falciparum. Intravenous artesunate injections have resulted in the resolution of symptoms of bowel obstruction. In conclusion, malaria should be suspected in any febrile patient with the features of bowel obstruction especially in an endemic area or if the patient has recently travelled to an endemic area with malaria. Treatment of malaria will result in the resolution of symptoms of functional bowel obstruction.