Acalculous Cholecystitis in a Pediatric Patient With Plasmodium Falciparum Infection: A Case Report and Literature Review

Aguilera‐Alonso, David; Medina, Eva María López; Rabes, T. del Rosal; Arrieta, Julián Villota; Escosa-García, Luis; García-Hortelano, Milagros

doi:10.1097/inf.0000000000001734

Cited by 8 publications

(11 citation statements)

References 8 publications

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“…Acute renal failure (ARF) has been reported in severe forms of malaria, such as blackwater fever (BWF), which is associated with high mortality rates of 15–45% if not managed promptly and correctly [ 8 ]. The clinical pathophysiology of malaria ARF is complex and multifactorial, including volume depletion, hypoxia, shock, hyperbilirubinemia, intravascular hemolysis, hyperparasitemia, and other factors [ 6 – 9 ]. Acute renal failure has the clinical and biochemical features of ischemic acute tubular necrosis (ATN).…”

Section: Discussionmentioning

confidence: 99%

“…Severe malaria is defined as the presence of P. falciparum malaria and any one of the following: Plasmodium falciparum parasitemia >10%, signs of organ dysfunction, including renal impairment (creatinine > 3 mg/dl), severe anemia (hemoglobin <6 g/dl), recurrent bleeding and bleeding disorders, acidosis, impaired consciousness, convulsions with two or more episodes in 24 hours, hypoglycemia (<40 mg/dl), pulmonary edema, and shock [ 1 – 4 ]. Some other rare but serious presentations of malaria are blackwater fever, disseminated intravascular coagulation (DIC), and malarial acute acalculous cholecystitis (AAC) [ 1 , 3 – 6 ]. We present an interesting case of severe malaria in the United States who unfortunately had all three rare complications of severe malaria with an excellent response to artesunate.…”

Section: Introductionmentioning

confidence: 99%

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Severe Malaria with a Rare Tetrad of Blackwater Fever, Acute Renal Failure, Disseminated Intravascular Coagulopathy, and Acute Acalculous Cholecystitis

Hanif

Shrestha

Munankami

et al. 2023

Case Reports in Infectious Diseases

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Background. Blackwater fever (BWF) is a severe clinical syndrome occurring as a complication of malarial infection characterized by intravascular hemolysis, hemoglobinuria, and acute renal failure in people exposed to Plasmodium falciparum and, to some extent, in people who were exposed to medications like quinine and mefloquine. The exact pathogenesis of classic BWF remains unclear. The mechanism leading to damage to the red blood cells (RBCs) can be immunologic nonimmunologic, leading to massive intravascular hemolysis. Case Presentation. We present a case of classic blackwater fever in a 24-year-old otherwise previously healthy male without any history of antimalarial prophylaxis use, returning from recent travel to Sierra Leone. He was detected to have P. falciparum malaria in the peripheral smear test. He was treated with artemether/lumefantrine combination therapy. Unfortunately, his presentation was complicated by renal failure and was managed with plasmapheresis and renal replacement therapy. Conclusion. Malaria continues to be a parasitic disease that can have devastating effects and continues to be a challenge globally. Although cases of malaria in the United States are rare and cases of severe malaria, mainly attributed to P. falciparum, are even more uncommon. Care should be taken to retain a high level of suspicion to consider the diagnosis, especially in returning travelers from endemic areas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe Malaria with a Rare Tetrad of Blackwater Fever, Acute Renal Failure, Disseminated Intravascular Coagulopathy, and Acute Acalculous Cholecystitis

Hanif

Shrestha

Munankami

et al. 2023

Case Reports in Infectious Diseases

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“…and more characteristic symptoms or signs related to cholestatic syndrome (tenderness in the right hypochondrium, Murphy's sign-painful palpation of the subcostal region during inspiration-jaundice and dark urine). [6][7][8][9] All patients underwent an ultrasound which showed findings of ACC (gall bladder wall thickening ≥ 3 mm, wall edema, distension >5 cm, biliary sludge or pericholecystic fluid). (3,10).…”

Section: Case Seriesmentioning

confidence: 99%

Case series of paediatric patients of acute acalculous cholecystitis associated with severe malaria in endemic region over past 3 years at single center

Vageriya

Inayath

Athawale

et al. 2022

Int J Contemp Pediatr

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Although acute acalculous cholecystitis (AAC) is a rare occurrence in all age groups; its incidence in paediatric patients is 50-60%. Yet ACC in children with malarial parasitic infection is extremely rare with only 12 cases reported as per English literature. We report 7 children with severe malaria developing ACC in a single institute in India over past 3 years. They were managed conservatively under strict observation and recovered completely without any surgical intervention. At a mean follow up of 1.5 years they are asymptomatic with a normal ultrasound imaging.

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“…Although acalculous cholecystitis is very uncommon in the pediatric population, it represents the major cause of cholecystitis, reaching up to 50-70% of all cholecystitis patients [65,70]. This increase in diagnosed cases may be attributed to the improvement in echographic imaging, whereby imaging has shown acute acalculous cholecystitis (AAC) presenting with wall thickening greater than or equal to 3 cm, biliary sludge, gallbladder distension (> 5 cm), and wall edema [71].…”

Section: Acalculous Cholecystitismentioning

confidence: 99%

A scoping review on acute gastrointestinal surgical complications in immunocompromised pediatric patients

et al. 2022

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Background Gastrointestinal complications are becoming increasingly more common and pose a significant risk on the health of children with compromised immunity caused by various etiologies such as chemotherapy and posttransplantation immunosuppression. We aim to review abdominal complications in immunocompromised children and their respective management. Main body This is a scoping review of the literature. PubMed, MEDLINE, Google Scholar, and Scopus libraries were searched for relevant articles. Extracted data included the etiologies of immunocompromised immunity, gastrointestinal and abdominal complications in immunocompromised children, diagnosis, and treatment of these pathologies. Examples of gastrointestinal complications in immunocompromised children include, but not limited to, neutropenic enterocolitis, acute appendicitis, bowel perforation, acalculous cholecystitis, and acute pancreatitis. Our literature review showed that bacterial and fungal infections are the major causes of exacerbation and mortality. The main cause of immunosuppression in children with neutropenic enterocolitis and acute pancreatitis is chemotherapy, and management of these pathologies using intravenous fluids, antibiotic therapy, and granulocyte-stimulating factors is the current standard of care. Surgical intervention is uncommon and reserved for complicated cases. That said, in acute appendicitis and bowel perforation, laparoscopy is the mainstay treatment. However, in systemic infections, nonsurgical interventions such as transfusion and bowel rest are the gold standard. As for acalculous cholecystitis, percutaneous cholecystectomy is superior to laparotomy and other surgical interventions. Conclusion Timely diagnosis and management of gastrointestinal complications in the immunocompromised children is key in reducing mortality and morbidity. Both surgical and nonsurgical interventions are needed and should be further studied in order to improve outcomes.

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Acalculous Cholecystitis in a Pediatric Patient With Plasmodium Falciparum Infection: A Case Report and Literature Review

Cited by 8 publications

References 8 publications

Severe Malaria with a Rare Tetrad of Blackwater Fever, Acute Renal Failure, Disseminated Intravascular Coagulopathy, and Acute Acalculous Cholecystitis

Severe Malaria with a Rare Tetrad of Blackwater Fever, Acute Renal Failure, Disseminated Intravascular Coagulopathy, and Acute Acalculous Cholecystitis

Case series of paediatric patients of acute acalculous cholecystitis associated with severe malaria in endemic region over past 3 years at single center

A scoping review on acute gastrointestinal surgical complications in immunocompromised pediatric patients

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