Acute respiratory distress syndrome and acute renal failure from Plasmodium ovale infection with fatal outcome

Abstract

BackgroundPlasmodium ovale is one of the causative agents of human malaria. Plasmodium ovale infection has long been thought to be non-fatal. Due to its lower morbidity, P. ovale receives little attention in malaria research.MethodsTwo Malaysians went to Nigeria for two weeks. After returning to Malaysia, they fell sick and were admitted to different hospitals. Plasmodium ovale parasites were identified from blood smears of these patients. The species identification was further confirmed with nested PCR. One of them was successfully treated with no incident of relapse within 12-month medical follow-up. The other patient came down with malaria-induced respiratory complication during the course of treatment. Although parasites were cleared off the circulation, the patient’s condition worsened. He succumbed to multiple complications including acute respiratory distress syndrome and acute renal failure.ResultsSequencing of the malaria parasite DNA from both cases, followed by multiple sequence alignment and phylogenetic tree construction suggested that the causative agent for both malaria cases was P. ovale curtisi.DiscussionIn this report, the differences between both cases were discussed, and the potential capability of P. ovale in causing severe complications and death as seen in this case report was highlighted.ConclusionPlasmodium ovale is potentially capable of causing severe complications, if not death. Complete travel and clinical history of malaria patient are vital for successful diagnoses and treatment. Monitoring of respiratory and renal function of malaria patients, regardless of the species of malaria parasites involved is crucial during the course of hospital admission.

Respiratory Complications of Plasmodium vivax Malaria: Systematic Review and Meta-Analysis

“…14 Recently, respiratory complications have also been reported in nonfalciparum malarias including P. vivax. [15][16][17][18][19][20][21][22] The underlying pathogenic mechanisms of respiratory complications associated with vivax malaria are not entirely understood. 23 Robust evidence for lung impairment in P. vivax malaria has only emerged recently.…”

Pulmonary complications of malaria: An update

“…Parasitic destruction releases toxins that cause endothelial damage and activate proinflammatory cytokines such as interleukin (IL)-1, 6 and 12 occurs, the tumour necrosis factor (TNF)␣ and platelet activating factor; these cytokines promote cell adhesion (parasitized red blood cells, leucocytes and platelets) to the endothelium, causing tissue hypoxia. [15][16][17] Some authors argue that the origin of endothelial damage in ARDS varies depending on the Plasmodium species: while in the case of P. falciparum the cause seems to be the same as in other complications (microvascular endothelium obstruction due to adhesion of the parasitized red blood cells), in other species this seems to have a minor role. These RBCs also adhere together to form structures called "rosettes" contributing to a reduced circulatory flow and multiorgan dysfunction.…”

Malaria with Pulmonary Complications

“…ARDS patients with Plasmodium vivax, Plasmodium ovale, and Plasmodium knowlesi were also reported despite it is the most common complication in Plasmodium falciparum malaria [10]. Two cases of Plasmodium ovale with ARDS were recently reported by Lau and colleagues [11]. Plasmodium falciparum causes the greatest severity and frequency of ARDS and could be partially attributed the resetting an sequestration of parasite-infected red blood cells in the pulmonary microcirculation [10].…”