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Kularatne D, Chulasiri P, Dharmapala A, Kularatne S. Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report. J Med Case Rep 2023; 17:509. [PMID: 38082342 PMCID: PMC10714539 DOI: 10.1186/s13256-023-04226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Plasmodium ovale malaria, which was previously endemic to tropical Africa and the Southwest Pacific islands is now being reported from parts of Asia. In Sri Lanka, the indigenous transmission of malaria has not been documented since October 2012. Since then, there have been several imported cases of malaria, including P. ovale, which have been detected sporadically. The reporting case of P. ovale was imported and detected incidentally in 2021, with several atypical presentations. CASE PRESENTATION A 40-year-old Sri Lankan medical doctor developed continuous fever with chills, rigors, and dysuria a day following removal of a large lipoma at the root of the neck under general anaesthesia. When the fever has been responding to antibiotics, on the 4th postoperative day a mild thrombocytopenia on complete blood count was detected. A blood smear which was done on the 5th postoperative day incidentally found a malaria parasite and confirmed as Plasmodium ovale with a density of 6535 parasites/microliter on the same day. He never had malaria in the past, but he had worked in South Sudan 1 year ago and visited India six months ago. On the 6th postoperative day, he was treated with chloroquine, and hyperparasitemia reduced rapidly by the next day. As the fever recurred with clinical deterioration, he was treated with different antibiotics. During the course of the illness, he did not develop pallor, or icterus except for a palpable soft spleen. The parasite count was zero on the 9th postoperative day and his fever subsided on the next day. Further, he was treated with primaquine to prevent future relapse and transmission. CONCLUSION A long incubation period, incidental detection of P ovale in a blood smear, and hyperparasitaemia are the atypical presentations of this case. Postoperative bacterial infection and stress may have reactivated the dormant malaria (hyponozoites) in this patient with an unusual picture. Coinfection of malaria with bacterial sepsis is a challenge in the management of the patient. As the Anopheles mosquito vector exists in Sri Lanka, the risk of indigenous transmission is high from such imported cases of P. ovale.
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Affiliation(s)
- Damsara Kularatne
- Center for Research in Tropical Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | - Arinda Dharmapala
- Department of Surgery, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Senanayake Kularatne
- Department of Medicine, Faculty of Medicine, University of Sri Lanka, Colombo, Sri Lanka
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Srbljanović J, Bobić B, Štajner T, Uzelac A, Opsenica I, Terzić-Jovanović N, Bauman N, Šolaja BA, Djurković-Djaković O. Aminoquinolines afford resistance to cerebral malaria in susceptible mice. J Glob Antimicrob Resist 2020; 23:20-25. [PMID: 32810640 DOI: 10.1016/j.jgar.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/07/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Malaria treatment is impeded by increasing resistance to conventional antimalarial drugs. Here we explored the activity of ten novel benzothiophene, thiophene and benzene aminoquinolines. METHODS In vitro testing was performed by the lactate dehydrogenase assay in chloroquine (CQ)-sensitive Plasmodium falciparum strain 3D7 and CQ-resistant (CQR) P. falciparum strain Dd2. In vivo activity was evaluated by a modified Thompson test using C57BL/6 mice infected with Plasmodium berghei ANKA strain. RESULTS Nine of the ten compounds had a lower 50% inhibitory concentration (IC50) than CQ against the CQR strain Dd2. Five of these compounds that were available for in vivo evaluation were shown to be non-toxic. All five compounds administered at a dose of 160mg/kg/day for 3 days prolonged the survival of treated compared with untreated mice. Untreated control mice died by Day 7 with a mean parasitaemia of 15%. Among treated mice, a dichotomous outcome was observed, with a two-third majority of treated mice dying by Day 17 with a low mean parasitaemia of 5%, whilst one-third survived longer with a mean hyperparasitaemia of 70%; specifically, five of these mice survived a mean of 25 days, whilst two even survived past Day 31. CONCLUSIONS The significant antimalarial potential of this aminoquinoline series is illustrated by its excellent in vitro activity against the CQRP. falciparum strain and significant in vivo activity. Interestingly, compounds ClAQ7, ClAQ9 and ClAQ11 were able to confer resistance to cerebral malaria and afford a switch to hyperparasitaemia to mice prone to the neurological syndrome.
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Affiliation(s)
- Jelena Srbljanović
- Institute for Medical Research, University of Belgrade, Dr. Subotića 4, P.O. Box 39, 11129 Belgrade, Serbia
| | - Branko Bobić
- Institute for Medical Research, University of Belgrade, Dr. Subotića 4, P.O. Box 39, 11129 Belgrade, Serbia
| | - Tijana Štajner
- Institute for Medical Research, University of Belgrade, Dr. Subotića 4, P.O. Box 39, 11129 Belgrade, Serbia
| | - Aleksandra Uzelac
- Institute for Medical Research, University of Belgrade, Dr. Subotića 4, P.O. Box 39, 11129 Belgrade, Serbia
| | - Igor Opsenica
- Faculty of Chemistry, University of Belgrade, Studentski trg 16, P.O. Box 51, 11158 Belgrade, Serbia
| | | | - Neda Bauman
- Institute for Medical Research, University of Belgrade, Dr. Subotića 4, P.O. Box 39, 11129 Belgrade, Serbia
| | - Bogdan A Šolaja
- Faculty of Chemistry, University of Belgrade, Studentski trg 16, P.O. Box 51, 11158 Belgrade, Serbia; Serbian Academy of Sciences and Arts, Knez Mihailova 35, 11000 Belgrade, Serbia
| | - Olgica Djurković-Djaković
- Institute for Medical Research, University of Belgrade, Dr. Subotića 4, P.O. Box 39, 11129 Belgrade, Serbia.
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Sylvester B, Gasarasi DB, Aboud S, Tarimo D, Massawe S, Mpembeni R, Swedberg G. Hyperparasitaemia during clinical malaria episodes in infants aged 0-24 months and its association with in utero exposure to Plasmodium falciparum. BMC Res Notes 2018; 11:232. [PMID: 29618382 PMCID: PMC5885461 DOI: 10.1186/s13104-018-3339-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/30/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Existing information has shown that infants who are prenatally exposed to P. falciparum are susceptible to subsequent malaria infections. However, the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes has not been fully elucidated. This study is a component of a prospective cohort study for which initial results have been published. This component was designed to determine the effect of prenatal exposure to P. falciparum on parasite density during clinical malaria episodes in the first 24 months of life. A total of 215 infants were involved and monitored for clinical malaria episodes defined by fever (≥ 37 °C) and parasitaemia. The geometric mean parasite counts between exposed and unexposed infants were compared using independent samples t test. The effect of in utero exposure to P. falciparum on parasite density was assessed using binary logistic regression. Results The geometric mean parasite count per µl of blood during clinical malaria episodes in exposed infants was 24,889 (95% CI 18,286–31,490) while in unexposed infants it was 14,035 (95% CI 12,111–15,960), P < 0.05. Prenatal exposure to P. falciparum was associated with hyperparasitaemia during clinical malaria episodes (OR 7.04, 95% CI 2.31–21.74), while other factors were not significantly associated (P > 0.05).
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Affiliation(s)
- Boniphace Sylvester
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania.
| | - Dinah B Gasarasi
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Donath Tarimo
- Department of Parasitology and Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Siriel Massawe
- Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar es Salaam, Tanzania
| | - Rose Mpembeni
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gote Swedberg
- Department of Medical Biochemistry and Microbiology, Biomedical Centre, Uppsala University, P.O.BOX 582, Uppsala, Sweden
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Stano P, Arzese A, Merelli M, Mascarello M, Maurel C, Avolio M, Bassetti M, De Rosa R, Luzzati R, Modolo ML, Scarparo C, Camporese A. Epidemiological and clinical features of imported malaria at the three main hospitals of the Friuli-Venezia Giulia Region, Italy. Infect Dis Health 2017; 23:17-22. [PMID: 30479299 DOI: 10.1016/j.idh.2017.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Imported malaria cases continue to occur in non-endemic regions among travellers returning from tropical and subtropical countries. At particular risk of acquiring malaria is the group of travellers identified as immigrants who return to their home country with the specific intent of visiting friends or relatives (VFRs) and who commonly believe they are immune to malaria and fail to seek pre-travel advice. Our aim was to review the current trends of imported malaria in the three main hospitals of the Friuli-Venezia Giulia region (FVG), North Eastern Italy, focusing in particular on patient characteristics and laboratory findings. METHODS In this retrospective study, we examined all malaria cases among patients admitted from January 2010 through December 2014 to the emergency department of the three main hospitals located in FVG. RESULTS During the 5-year study period from 2010 to 2014, there were a total of 140 patients with a diagnosis of suspected malaria and who received microscopic confirmation of malaria. The most common species identified was P. falciparum, in 96 of 140 cases (69%), followed by P. vivax (13%), P. ovale (4%), P. malariae (4%), and mixed infection (4%). The most common reason for travel was VFRs (54%), followed by work (17%), and recent immigration (15%). Moreover, 78% of all patients took no chemoprophylaxis, 80 (79%) of whom were foreigners. Notably, the percentage of Italian travellers who took chemoprophylaxis was only 20% (8 of 39 Italian cases), and the regimen was appropriate in only four cases. Parasitaemia greater than 5% was observed in 11 cases (10%), all due to P. falciparum infection. CONCLUSIONS We highlight that VFRs have the highest proportion of malaria morbidity and the importance of improving patient management in this category. These data are useful for establishing appropriate malaria prevention measures and recommendations for international travellers.
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Affiliation(s)
- Paola Stano
- Clinical Microbiology and Virology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria N.5 "Friuli Occidentale", Hospital of Pordenone, Via Montereale, 24, 33170 Pordenone, Italy.
| | - Alessandra Arzese
- Microbiology Laboratory Unit, Azienda Sanitaria Universitaria Integrata, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria Della Misericordia, 15, 33100, Udine, Italy; Department of Medicine, University of Udine, Piazzale Kolbe, 4, 33100 Udine, Italy.
| | - Maria Merelli
- Infectious Diseases Division, Azienda Sanitaria Universitaria Integrata, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria Della Misericordia, 15, 33100, Udine, Italy.
| | - Marta Mascarello
- Infectious Diseases Unit, University Hospital of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
| | - Cristina Maurel
- Infectious Diseases Unit, University Hospital of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
| | - Manuela Avolio
- Clinical Microbiology and Virology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria N.5 "Friuli Occidentale", Hospital of Pordenone, Via Montereale, 24, 33170 Pordenone, Italy.
| | - Matteo Bassetti
- Infectious Diseases Division, Azienda Sanitaria Universitaria Integrata, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria Della Misericordia, 15, 33100, Udine, Italy; Department of Medicine, University of Udine, Piazzale Kolbe, 4, 33100 Udine, Italy.
| | - Rita De Rosa
- Clinical Microbiology and Virology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria N.5 "Friuli Occidentale", Hospital of Pordenone, Via Montereale, 24, 33170 Pordenone, Italy.
| | - Roberto Luzzati
- Infectious Diseases Unit, University Hospital of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
| | - Maria Luisa Modolo
- Clinical Microbiology and Virology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria N.5 "Friuli Occidentale", Hospital of Pordenone, Via Montereale, 24, 33170 Pordenone, Italy.
| | - Claudio Scarparo
- Microbiology Laboratory Unit, Azienda Sanitaria Universitaria Integrata, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria Della Misericordia, 15, 33100, Udine, Italy.
| | - Alessandro Camporese
- Clinical Microbiology and Virology Laboratory, Department of Laboratory Medicine, Azienda per l'Assistenza Sanitaria N.5 "Friuli Occidentale", Hospital of Pordenone, Via Montereale, 24, 33170 Pordenone, Italy.
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