Pancytopenia with hemophagocytic lymphohistiocytosis in Plasmodium falciparum: A unusual presentation

Chaudhry, Shewta; Arya, Aditi; Matlani, Monika; Singh, Vineeta; Meena, Swati

doi:10.4103/tp.tp_34_20

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Trop Parasitol

2021

DOI: 10.4103/tp.tp_34_20

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Pancytopenia with hemophagocytic lymphohistiocytosis in Plasmodium falciparum: A unusual presentation

Shewta Chaudhry

Aditi Arya

Monika Matlani

et al.

Abstract: Hematological manifestations such as anemia and thrombocytopenia are known complications in malaria. Here, we report two cases presented as pancytopenia with hepatosplenomegaly and initial diagnosis kept as hematological malignancy like leukemia but later on its diagnosed as malaria-associated hemophagocytic lymphohistiocytosis which is a rare entity. The aim of this report is to draw the attention of physicians, especially in tropical countries such as India and Sub-Saharan nations to keep in mind this uncomm… Show more

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Cited by 3 publications

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Hemophagocytic lymphohistiocytosis—how common and how severe is it as a complication of malaria? Retrospective case series and review of the literature

Orth,

Wiemer,

Schneitler

et al. 2023

Infection

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Background Infection-associated secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially life-threatening hyperinflammatory condition caused by various infectious diseases. Malaria has rarely been described as trigger. The aim of this study is to collect data on frequency, clinical spectrum, and outcome of sHLH induced by malaria. Methods We collected case numbers on malaria and malaria-associated sHLH from specialized centers in Germany from 2015 to 2022. In addition, we conducted a literature search on published cases of malaria-associated sHLH and systematically analyzed the literature regarding clinical and diagnostic criteria. Results We obtained data from 13 centers treating 1461 malaria cases with different Plasmodium species, of which 5 patients (0.34%) also were diagnosed with sHLH. The literature search revealed detailed case reports from further 51 patients and case series comprising the description of further 24 patients with malaria-associated sHLH. Most cases (48/80; 60%) were reported from Asia. The median time interval between onset of malaria symptoms and hospital admission was 7 days. Severe complications of sHLH were documented in 36% (20/56) of patients, including two patients with multiple organ failure in our case series. Only 41% (23/56) of patients received specific treatment for sHLH, nevertheless the mortality rate (CFR) of 5% is lower compared to the CFR reported for sHLH triggered by other infectious diseases (e.g., 25% in sHLH due to EBV infection). Conclusion Malaria-associated sHLH appears to have a comparatively good prognosis but may still represent an underdiagnosed and potentially fatal complication of malaria, especially in resource-poor settings.

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Hemophagocytic lymphohistiocytosis—how common and how severe is it as a complication of malaria? Retrospective case series and review of the literature

Orth,

Wiemer,

Schneitler

et al. 2023

Infection

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show abstract

Trends in clinical features and severity of Plasmodium vivax malaria among children at tertiary care center in North India

Arya,

Meena,

Matlani

et al. 2023

Journal of Tropical Pediatrics

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Background Malaria is a significant cause of morbidity and mortality in adults and children. Plasmodium falciparum is the primary cause of severe malaria, but recently Plasmodium vivax is also recognized to cause severe malaria-associated morbidity and mortality. The study focuses on determining the mortality related to severity parameters in individuals under 12 years and their critical presentation in P.vivax malaria-infected children. Methods A prospective cross-sectional hospital-based study was conducted at Safdarjung Hospital, New Delhi, and ICMR-NIMR, New Delhi. All clinically suspected cases were admitted for screening. Exclusion criteria (rapid malaria antigen test, microscopy and medication history) were applied to all the admitted patients (n = 221) to obtain P.vivax patients only. Patients aged ≤ 12 years were included in the study. DNA was extracted from dried blood spots and amplified by nested PCR, followed by visualization on gel electrophoresis. Result A total of 221 clinically suspected cases of malaria were screened for P.vivax. After implementing various exclusion criteria, 45/221 cases were enrolled for the study, among which 44.4% (20/45) of children had the symptoms of severe malaria in terms of cerebral malaria, thrombocytopenia, anemia, pancytopenia, acute respiratory distress syndrome and hemophagocytic lymphohistiocytosis. Conclusion Plasmodium vivax mono-infection can cause severe manifestation and must be treated as P.falciparum without any delay because it may lead to increased morbidity and mortality. A changing trend in clinical symptoms has shown in P.vivax which was an earlier phenomenon of P.falciparum.

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A Case of Malaria-Associated Hemophagocytic Lymphohistiocytosis

Almajed¹,

Cerna-Viacava²,

Priessnitz³

et al. 2022

Cureus

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Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory syndrome of inappropriate and excessive immune system activation. It often occurs in the setting of viral, bacterial, fungal, and parasitic infections. HLH associated with malaria is very rare, and literature on this association is limited. Significant overlap exists between these two conditions, which makes the diagnosis of HLH superimposed on malaria difficult. We present a case of a patient who recently traveled from Djibouti and was diagnosed with Plasmodium falciparum malaria. She had a transient improvement in response to antimalarial therapy followed by clinical deterioration. This prompted further investigations that revealed the diagnosis of HLH, which was confirmed by an elevated soluble interleukin-2 receptor CD25 (sCD25) level, a specific marker of HLH. Most patients recover with antimalarial therapy, supportive care, and monitoring, whereas some patients require immunosuppressive therapy. Maintaining a high index of suspicion for HLH-associated malaria in at-risk patients allows for early identification and management.

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Pancytopenia with hemophagocytic lymphohistiocytosis in Plasmodium falciparum: A unusual presentation

Cited by 3 publications

References 8 publications

Hemophagocytic lymphohistiocytosis—how common and how severe is it as a complication of malaria? Retrospective case series and review of the literature

Hemophagocytic lymphohistiocytosis—how common and how severe is it as a complication of malaria? Retrospective case series and review of the literature

Trends in clinical features and severity of Plasmodium vivax malaria among children at tertiary care center in North India

A Case of Malaria-Associated Hemophagocytic Lymphohistiocytosis

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