Hemophagocytic syndrome associated with severe Plasmodium vivax malaria in a child in Bikaner (northwestern India) (original) (raw)

Hemophagocytic syndrome in Plasmodium vivax malaria

Journal of vector borne diseases, 2014

Malaria is one of the most common infectious diseases and a major public health problem. It afflicts >500 million people causing more than one million deaths each year worldwide 1 . The association of pancytopenia in severe malaria due to Plasmodium vivax in children with hemophagocytic syndrome is extremely rare and very few cases are reported in the world literature 2 .

A case of hemophagocytic syndrome as a complication of <i>Plasmodium</i> vivax malaria

Open Journal of Clinical Diagnostics, 2013

Hemophagocytic lymphohistiocytosis syndrome (HPS) is a potentially fatal hyperinflammatory response characterized by a generalized histiocytic proliferation with marked hemophagocytosis in bone marrow [1]. Hemophagocytic syndrome has been associated with genetic mutations, autoimmune diseases, hematological malignancies or infections [2,3]. According to the data from Centre for Disease Control and prevention (CDC) Plasmodium falciparum has been associated with HPS but not the Plasmodium vivax [4-7]. We report a case of hemophagocytic syndrome as a complication of Plasmodium vivax malaria which is a rare presentation according to the data. This patient presented with high grade fever with chills (P. vivax positive), fever however did not respond to anti-malarials. The patient continued to have high grade fever with altered sensorium and deranged liver function with pancytopenia. Since she fulfilled the criteria of (HPS), patient was put on injectable steroids and responded dramatically. Hemophagocytic syndrome is a potentially fatal syndrome and therefore high index suspicion and early treatment is the key to reduce the mortatlity.

Hemophagocytic Syndrome in a Four Year Old Male Child with Plasmodium Vivax Infection

Journal of Nepal Paediatric Society, 2016

In Hyper endemic zones Malaria is known to present with unusual complications. Haemophagocytic syndrome is a disorder of mononuclear phagocytic syndrome. There are many published reports of haemophagocytic syndrome due to P. falciparum infection but haemophagocytic syndrome due to P. vivax infection is quite rare.

Rare Case of Isolated Plasmodium Vivax Malaria Presenting with Pancytopenia: A Case Report

BJSTR

Pancytopenia is a triad of simultaneous drop in all the three major blood cells including Hemoglobin, White blood cells and Platelets. Etiology of pancytopenia is diverse comprising both hematopoietic and non-hematopoietic disorders including various infections. Malaria is a rare cause of pancytopenia which mostly occur with Plasmodium falciparum and very few cases reported with Plasmodium vivax. This is a case of a 17-year-old girl with no previous co-morbids presented with high grade fever, vomiting, loose motions and decrease appetite for 5 days. On examination she was dehydrated and pale with bruising on arms and thighs. Spleen was palpable. Rest of systemic examination was unremarkable. Complete blood picture showed decreased TLC, Low Hemoglobin and Thrombocytopenia. Liver function tests, Renal function tests, Serum electrolytes, Urine routine examination and Erythrocyte sedimentation rate were normal. C-reactive protein, LDH, Ferritin and D-dimers were raised. Peripheral film showed Retic count of 3%. Dengue serology and Covid-19 PCR was negative. Blood and Urine Cultures showed no growth. Ultrasound abdomen showed splenomegaly. Peripheral smear for Malarial Parasite showed early trophozoites of Plasmodium vivax. Patient was started on Intravenous Artesunate as she could not tolerate Oral antimalarial. Patient became afebrile and blood counts improved after few days and was discharged with follow up test for G6PD assay.

Changing trends in the clinical and hematological profile of Plasmodium vivax mono infection

International Journal of Current Research in Medical Sciences

Background: Malaria continues to be a major public health problem in South East Asia. Plasmodium vivax is the most widely distributed human malaria parasite with an at-risk population of 2.5 billion persons. With the implementation of molecular diagnosis, it has become evident that P.vivax mono infection could also result in multiple organ dysfunction and severe life-threatening disease as seen in P. falciparum infection. Objectives: To study the changing trends in the clinical and hematological presentation of the Plasmodium vivax malaria and to sensitize the health care provider about the changing presentation of the Plasmodium vivax mono infection and to introduce a high index of suspicion against it's potentially life threatening complications hitherto considered not significantly prevalent, by printing and publishing the data thus obtained and circulating it amongst the health care providers in and around Amritsar. Methods: This is a single center prospective study including 100 children attending thalassemia day care center and on regular blood transfusion therapy for a minimum of 2 years and whose ferritin level is above 1000 μgm/dl. Detailed history and examination were recorded in the proforma. Blood was drawn for thyroid function tests and most recent ferritin value obtained from patients record was used for analysis. Results: A total of 55 cases of vivax malaria were included in the study. Severe disease was present in 19(34.5%) cases of malaria. In addition to fever, the most common clinical features at presentation in children were: fatigue in 96.4%(53/55), headache in 54% (30/55), myalgia in 54%(30/55), arthralgia in 43%(24/55), vomiting in 64% (35/55) and nausea in 58%(32/55).Hepatosplenomegaly in 51% (28/55) of patients, splenomegaly in 26% (14/55) and hepatomegaly alone in 3% (2/55), varying degrees of icterus in 20% (11/55) and respiratory distress in 12.7% (7/55). Anemia was present in 89.1% (49/55) and thrombocytopenia (platelet count < 1,50,000/μL) was present in 45.5% (25/55) of the children.

Haemophagocytic Syndrome in a 19-Year-Old Male with Plasmodium falciparum Malaria

European Journal of Case Reports in Internal Medicine, 2014

Objectives: Infectious agents triggering haemophagocytic lymphohistiocytosis (HLH) primarily involve the herpes virus group. We report a case of HLH precipitated by Plasmodium falciparum. Materials and methods: Clinical and laboratory findings in a patient presenting with fever were collected. After confirmation of acute malaria, anti-malarial treatment was administered. Results: Despite initial favourable evolution, the patient developed fever again together with a worsening of the haematological parameters and increased ferritin levels. A bone marrow biopsy confirmed the diagnosis of HLH. Conclusion: This case illustrates that HLH should be considered in the differential diagnosis of acute malaria in patients with persisting fever and pancytopenia.

Haemophagocytic lymphohistiocytosis: a cause of unresponsive malaria in a 5-year-old girl

Paediatrics and International Child Health, 2014

A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum). Fever was persistent despite antimalarials in the absence of any coexisting bacterial or viral infection. Laboratory findings included cytopaenia, hyperbilirubinaemia, hyperferritinaemia, hypertriglyceridaemia, hyponatraemia, deranged partial thromboplastin time, decreasing ESR and megaloblastic changes on bone marrow aspiration. A final diagnosis of haemophagocytic lymphohistiocytosis (HLH) with megaloblastic anaemia associated with severe mixed malaria was made. There was a dramatic response to corticosteroid treatment with improvement in her clinical condition. This report endorses the use of corticosteroids in malaria-associated HLH whenever there is no clinical improvement with antimalarials alone.