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Marteau A, Ouedraogo E, Van der Meersch G, Akhoundi M, Souhail B, Cohen Y, Bouchaud O, Izri A. Severe long-delayed malaria caused by Plasmodium malariae in an elderly French patient. Malar J 2021; 20:337. [PMID: 34353333 PMCID: PMC8340512 DOI: 10.1186/s12936-021-03870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Plasmodium malariae is the cause of the rare but severe form of malaria that sometimes affects individuals travelling to malaria-endemic regions. This report presents the unique case of a patient exhibiting severe malaria symptoms caused by P. malariae with no record of recent travel to any malaria-endemic areas. CASE PRESENTATION An 81-year-old French woman was admitted to the emergency department with sustained fever and severe weakness for the past 5 days. She suffered from anaemia, thrombocytopenia, confusion, somnolence, pulmonary complications, and hypoxaemia. In the absence of any concrete aetiology that could explain the fever together with thrombocytopenia, physicians suspected malaria as a probable diagnosis. The LAMP-PCR and lateral flow test confirmed the presence of malaria parasite, Plasmodium sp. Microscopic examination (May-Grünwald Giemsa-stained thin blood smear) revealed the presence of trophozoites, schizonts, and gametocytes with 0.93 % parasitaemia. Conventional PCR amplification targeting 510 bp DNA fragment of small subunit ribosomal RNA (ssrRNA) and bidirectional sequencing identified the parasite as Plasmodium malariae. The travel history of this patient revealed her visits to several countries in Europe (Greece), North Africa (Tunisia and Morocco), and the West Indies (Dominican Republic). Of these, the latter was the only country known to be endemic for malaria at the time (three malaria parasite species were prevalent: Plasmodium falciparum, Plasmodium vivax, and P. malariae). The patient had most likely got infected when she visited the Dominican Republic in the summer of 2002. This time interval between the initial parasite infection (2002) till the onset of symptoms and its subsequent diagnosis (2020) is a reminder of the ability of P. malariae to persist in the human host for many years. CONCLUSIONS This report highlights the persistent nature and ability of P. malariae to cause severe infection in the host even after a prolonged time interval.
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Affiliation(s)
- Anthony Marteau
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, 125, route de Stalingrad, 93009, Bobigny cedex, France
| | - Elise Ouedraogo
- Infectious diseases Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Guillaume Van der Meersch
- Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Mohammad Akhoundi
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, 125, route de Stalingrad, 93009, Bobigny cedex, France.
| | - Berenice Souhail
- Infectious diseases Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Yves Cohen
- Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Olivier Bouchaud
- Infectious diseases Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Arezki Izri
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, 125, route de Stalingrad, 93009, Bobigny cedex, France
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection), Marseille, France
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