Prolonged parasite clearance in a Chinese splenectomized patient with falciparum malaria imported from Nigeria View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-04-04

AUTHORS

Hong-Wei Zhang, San-Jin Li, Tao Hu, Yong-Min Yu, Cheng-Yun Yang, Rui-Min Zhou, Ying Liu, Jing Tang, Jing-Jing Wang, Xiu-Yun Wang, Yong-Xiang Sun, Zhan-Chun Feng, Bian-Li Xu

ABSTRACT

BackgroundThe 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 presentationA 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.ConclusionsThis 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. More... »

PAGES

44

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s40249-017-0259-5

DOI

http://dx.doi.org/10.1186/s40249-017-0259-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1083941639

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28372588


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28 schema:description BackgroundThe 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 presentationA 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.ConclusionsThis 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.
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35 China
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38 Henan Province
39 K13-propeller gene
40 Nigeria
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42 Province
43 Zhumadian City
44 abnormalities
45 artemisinin resistance
46 artemisinin treatment
47 axillary temperature
48 blood
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52 cases
53 cells
54 chemoprophylaxis
55 chills
56 city
57 clearance
58 construction workers
59 day 0
60 day 21
61 day 23
62 day 24
63 day 3
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65 days
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71 genes
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75 hospital
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92 pivotal role
93 prolonged parasite clearance
94 rapid clearance
95 red blood cells
96 reference sequence
97 resistance
98 role
99 sequence
100 smears
101 spleen
102 splenectomized patients
103 splenectomy
104 symptoms
105 temperature
106 time
107 total
108 treatment
109 workers
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