Rare Case of Isolated Plasmodium Vivax Malaria Presenting with Pancytopenia: A Case Report (original) (raw)
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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 .
Journal of vector borne diseases, 2013
Hemophagocytic syndrome (HPS) is a reactive disorder of the mononuclear phagocytic system, characterized by benign, generalized histiocytic proliferation, with marked hemophagocytosis in bone marrow 1 . Generally, HPS has been related with hematologic diseases, autoimmune diseases, or with various infections 1 . There are plenty of reports on hemophagocytic syndrome associated with Plasmodium falciparum monoinfetion 2-9 , but reports on the association with P. vivax monoinfection are very scanty 9-14 . In most of these case reports, the diagnosis was made by peripheral blood smear (PBS) and rapid diagnostic test (RDT) without molecular diagnostic confirmation. Thus, there are always chances of species misidentification and missing the mixed infection thereby lacking authenticity. In this case report, the species diagnosis was confirmed by polymerase chain reaction (PCR) and possibilities of other diseases were ruled out by stringent laboratory and biochemical investigations to establish the firm association of hemophagocytic syndrome with P. vivax monoinfection.
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.
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.
Anemia and Thrombocytopenia in Children with Plasmodium vivax Malaria
Journal of Tropical Pediatrics, 2006
Clinico-epidemiological features of pediatric patients with malaria due Plasmodium vivax that developed anemia and thrombocytopenia requiring hospitalization are herein reported. Over a 3-year period, 78 children with P. vivax infection were admitted to our Hospital in Sucre, Venezuela. Clinical manifestations at admission were 93.59 per cent fever, 41.03 per cent chills and 14.10 per cent headache, among others. On paraclinical evaluations 94.87 percent presented with anemia (10.26 per cent severe), 25.64 percent with malnutrition, and 10.26 percent had intestinal parasitosis. The mean hemoglobin levels on admission were 8.09 g/dl and mean platelet counts 127 402 cells/mm 3. Among these patients 58.97 per cent developed thrombocytopenia (24.36 per cent severe) requiring transfusion in 25.64 per cent of patients. After antimalarial treatment with chloroquine and primaquine and supportive care all patients were successfully discharged. No deaths or further complications were seen, except for persistent mild thrombocytopenia in 17.95 per cent of the patients.
Saudi medical journal, 2007
To evaluate hemoglobin, leukocyte, platelet counts and red cell distribution width values during acute vivax malaria. This study, which comprises 90 symptomatic vivax malaria patients compared with 52 healthy controls, investigated hemoglobin, leukocyte, platelet counts and red cell distribution width values during acute disease prior to the treatment in vivax malaria, from May 2002 to December 2004 in Adana, Cukurova region, located in the southern part of Turkey, along the Mediterranean coast. Mean values for hemoglobin, leukocyte and platelet counts in the vivax malaria group in our study were found to be significantly lower in comparison to the control group. Anemia and thrombocytopenia were also observed in the malaria group while not in the control group (p<0.05, p<0.0001). Mean red cell distribution width values were found to be significantly higher in the malaria group (p<0.0001). Our findings indicated that routinely used laboratory findings such as low hemoglobin,...
The journal of the Royal College of Physicians of Edinburgh, 2021
Eradication therapy in Plasmodium vivax in variants of glucose-6-phosphate dehydrogenase (G6PD) deficiency individuals remains a clinical challenge. We present a case of primaquine-induced methaemoglobinaemia and haemolytic anaemia in a patient with falsely normal qualitative G6PD result during initial presentation, which was complicated with clinical sequelae of thrombosis. Further investigations showed moderate degree of G6PD deficiency. Our patient responded well to vitamin C and a modified weekly regimen of primaquine with no evidence of malaria relapse.