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Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria
BACKGROUND: The spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment. Prolonged parasite clearance can be found in patients who have had a splenectomy, or those with hemoglobin abnormalities and/or reduced i...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379605/ https://www.ncbi.nlm.nih.gov/pubmed/28372588 http://dx.doi.org/10.1186/s40249-017-0259-5 |
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author | Zhang, Hong-Wei Li, San-Jin Hu, Tao Yu, Yong-Min Yang, Cheng-Yun Zhou, Rui-Min Liu, Ying Tang, Jing Wang, Jing-Jing Wang, Xiu-Yun Sun, Yong-Xiang Feng, Zhan-Chun Xu, Bian-Li |
author_facet | Zhang, Hong-Wei Li, San-Jin Hu, Tao Yu, Yong-Min Yang, Cheng-Yun Zhou, Rui-Min Liu, Ying Tang, Jing Wang, Jing-Jing Wang, Xiu-Yun Sun, Yong-Xiang Feng, Zhan-Chun Xu, Bian-Li |
author_sort | Zhang, Hong-Wei |
collection | PubMed |
description | BACKGROUND: The spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment. Prolonged parasite clearance can be found in patients who have had a splenectomy, or those with hemoglobin abnormalities and/or reduced immunity, which are all distinguishable from artemisinin resistance. This paper reports on a case of prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria. CASE PRESENTATION: A 35-year-old Chinese male suffered 2 days of febrile illness after returning to Zhumadian city of Henan province from Nigeria on October 1, 2014. The main symptoms were febrile, including the highest axillary temperature of 40 °C, headache, and chills. A peripheral blood smear showed parasitemia (53 913 asexual parasites/μl) of Plasmodium falciparum. The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014. The patient had three episodes of malaria in Nigeria and had a splenectomy due to a traffic accident 8 years ago from the time he was admitted to hospital. The patient was orally administrated a total of 320 mg/2.56 g dihydroartemisinin-piperaquine for 2 days and intravenously administrated a total of 3 000 mg artesunate for 18 days. The axillary temperature of the patient ranged between 37.0 and 37.7 °C from Day 0 to Day 3, and blood microscopy revealed falciparum malaria parasitemia (26 674 asexual parasites/μl) on Day 3. The patient was afebrile on Day 4, falciparum malaria parasitemia was continuously present and then gradually decreased on the next days, and was negative on Day 21. The patient was cured and left hospital on Day 24 after no plasmodium falciparum was found in the blood on Day 21 to Day 23. No mutation was found in the K13 propeller gene when compared with the PF3D7_1343700 K13 propeller gene reference sequence. CONCLUSIONS: This is the first reported case in China of prolonged parasite clearance in a splenectomized patient with imported falciparum malaria. Artemisinin resistance should be distinguished when prolonged parasite clearance is found in a malaria patient who has had splenectomy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40249-017-0259-5) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5379605 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-53796052017-04-07 Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria Zhang, Hong-Wei Li, San-Jin Hu, Tao Yu, Yong-Min Yang, Cheng-Yun Zhou, Rui-Min Liu, Ying Tang, Jing Wang, Jing-Jing Wang, Xiu-Yun Sun, Yong-Xiang Feng, Zhan-Chun Xu, Bian-Li Infect Dis Poverty Case Study BACKGROUND: The spleen plays a pivotal role in the rapid clearance of parasitized red blood cells in patients with falciparum malaria after artemisinin treatment. Prolonged parasite clearance can be found in patients who have had a splenectomy, or those with hemoglobin abnormalities and/or reduced immunity, which are all distinguishable from artemisinin resistance. This paper reports on a case of prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria. CASE PRESENTATION: A 35-year-old Chinese male suffered 2 days of febrile illness after returning to Zhumadian city of Henan province from Nigeria on October 1, 2014. The main symptoms were febrile, including the highest axillary temperature of 40 °C, headache, and chills. A peripheral blood smear showed parasitemia (53 913 asexual parasites/μl) of Plasmodium falciparum. The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014. The patient had three episodes of malaria in Nigeria and had a splenectomy due to a traffic accident 8 years ago from the time he was admitted to hospital. The patient was orally administrated a total of 320 mg/2.56 g dihydroartemisinin-piperaquine for 2 days and intravenously administrated a total of 3 000 mg artesunate for 18 days. The axillary temperature of the patient ranged between 37.0 and 37.7 °C from Day 0 to Day 3, and blood microscopy revealed falciparum malaria parasitemia (26 674 asexual parasites/μl) on Day 3. The patient was afebrile on Day 4, falciparum malaria parasitemia was continuously present and then gradually decreased on the next days, and was negative on Day 21. The patient was cured and left hospital on Day 24 after no plasmodium falciparum was found in the blood on Day 21 to Day 23. No mutation was found in the K13 propeller gene when compared with the PF3D7_1343700 K13 propeller gene reference sequence. CONCLUSIONS: This is the first reported case in China of prolonged parasite clearance in a splenectomized patient with imported falciparum malaria. Artemisinin resistance should be distinguished when prolonged parasite clearance is found in a malaria patient who has had splenectomy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40249-017-0259-5) contains supplementary material, which is available to authorized users. BioMed Central 2017-04-04 /pmc/articles/PMC5379605/ /pubmed/28372588 http://dx.doi.org/10.1186/s40249-017-0259-5 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Study Zhang, Hong-Wei Li, San-Jin Hu, Tao Yu, Yong-Min Yang, Cheng-Yun Zhou, Rui-Min Liu, Ying Tang, Jing Wang, Jing-Jing Wang, Xiu-Yun Sun, Yong-Xiang Feng, Zhan-Chun Xu, Bian-Li Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria |
title | Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria |
title_full | Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria |
title_fullStr | Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria |
title_full_unstemmed | Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria |
title_short | Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria |
title_sort | prolonged parasite clearance in a chinese splenectomized patient with falciparum malaria imported from nigeria |
topic | Case Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5379605/ https://www.ncbi.nlm.nih.gov/pubmed/28372588 http://dx.doi.org/10.1186/s40249-017-0259-5 |
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