The Diagnostic Value of Bone-Marrow Biopsy in Malaria Caused by<i>Plasmodium Falciparum</i>

Fj, Zacharias

doi:10.1080/00034983.1949.11685414

Cited by 7 publications

(8 citation statements)

References 5 publications

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“…Indeed, recent work with P. vivax in splenectomized rhesus macaques demonstrated those spaces of bone marrow as the dominant compartment of that infection [7]. Plasmodium falciparum has also been shown to interact with bone marrow; employing it as a site of maturation and for evasion of the host immune response [8][9][10][11][12][13]. For initiation of active P. falciparum merozoites entry, the erythrocyte binding-like (EBL) and reticulocyte binding-like (Rh) protein families are responsible for binding to specific erythrocyte receptors [14].…”

Section: Introductionmentioning

confidence: 99%

“…The presence of malarial parasites in the bone marrow was first reported in 1894 in malarial fevers occurring during summer and autumn [20]. Later, bone marrow aspiration was described as an accessory and useful tool in the diagnosis of malaria especially in cases where strong suspicion of malaria could not be confirmed on routine peripheral smears [9][10][11]. Peripheral smear examination under light microscopy remains the gold standard of malaria diagnosis and consistently negative findings in a patient are considered definitive.…”

Section: Introductionmentioning

confidence: 99%

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Plasmodium in the bone marrow: case series from a hospital in Pakistan, 2007–2015

Shaikh

Ali

Janjua

et al. 2021

Malar J

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Background Malaria is a life-threatening, multisystem disease caused by the plasmodial parasite with a global incidence of approximately 229 million annually. The parasites are known to have unique and crucial interactions with various body tissues during its life cycle, notably the liver, spleen, and recent work has shown the bone marrow to be a reservoir of infection. Methods This study is a case series of patients in whom examination of bone marrow revealed malarial parasites. A retrospective record review of 35 parasite-positive bone marrow specimens examined at Aga Khan University Hospital (AKUH), Karachi, Pakistan, over the years 2007 to 2015 was conducted. Bone marrow aspirates were collected as per International Council for Standardization in Haematology (ICSH) guidelines. Results The median age of patients was 22 years (range 1–75), and 60 % (n = 21) were male. 22 patients had evidence of Plasmodium falciparum, 12 had evidence of Plasmodium vivax and 1 patient had a mixed infection. Gametocytes and trophozoites were the most common stages identified on both peripheral blood and bone marrow examinations. Indications for bone marrow examination included fever of unknown origin and the workup of cytopenias and malignancies. Conclusions The incidental finding of Plasmodium in samples of bone marrow suggests the reticuloendothelial system may be regularly harbour these parasites, be the infection acute or chronic in character.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Plasmodium in the bone marrow: case series from a hospital in Pakistan, 2007–2015

Shaikh

Ali

Janjua

et al. 2021

Malar J

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“…The hemogram blood test results of patients with Plasmodium infection in the bone marrow concur with the consensus regarding the initiation of bone marrow puncture for the diagnosis of malaria: For patients with atypical manifestations, especially those who exhibit pancytopenia and febrile neutropenia [37], more invasive screening test, such as bone marrow puncture, could be performed to exclude malaria infection [38][39]. However, bone marrow puncture should be avoided for patients with acute attack of malaria, who exhibit clinical symptoms and more pronounced pancytopenia in the peripheral blood, due to the concern of unjusti ed procedure [40,5]. In summary, the appropriate candidates for bone marrow puncture of Plasmodium testing are those with a traveling history to malaria-endemic areas, exhibition of fever, anemia, thrombocytopenia and splenomegaly, undetected Plasmodium in the peripheral blood, suspicious antigen test results, as well as the exclusion of other microbial infections, such as bacteria and mycoplasma.…”

Section: Discussionmentioning

confidence: 99%

Examination of Plasmodium parasites in bone marrow puncture fluid for the diagnosis of imported malaria patients in Yunnan Province, China

Huang

Dong

et al. 2022

Preprint

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BackgroundChina has been certified as a malaria-free country by World Health Organization (WHO) in June 2021, yet the pressure of preventing the dissemination of imported malaria persists and thus calling for continued effort of timely detection and management. To compensate for the risk of missed diagnosis of using peripheral blood alone, medical institutions in Yunnan Province launched bone marrow puncture to confirm malaria Plasmodium infection more accurately. Methods Patients with a recent history of travelling to malaria-endemic areas outside of China, who were excluded from microbial infections such as tuberculosis and exhibited persistent abnormalities, including hepatosplenomegaly and decreased platelet pressure and the negative for Plasmodium lactate dehydrogenase (pLDH) antigen in the peripheral blood, were enrolled in the study. The cases ware conducted the bone marrow aspirate from anterior superior iliac spine to screen for Plasmodium infection in bone marrow fluid. Then the pLDH genes of the infected strains from cases ware amplified by conducted nested PCR. The amplification products were sequenced, and the B-cell epitopes and the oligomeric spatial structures of the pLDH peptide chains were analyzed.Results Bone marrow puncture was performed on 5 eligible subjects in total. The Plasmodium were found in the bone marrow fluid from all cases, which included two patients with pLDH-negative and three patients with pLDH-positive in peripheral blood detected by malaria rapid tests (RDTs). Two pLDH negative cases under malaria RDTs were diagnosed as Plasmodium vivax infection, with the proportion of ring stage, large trophozoites, schizonts, and stage III-V gametocytes reaching 28.3%, 38.3%, 4.8%, 11.5%, 16.5% and 0.8%, respectively. The erythrocyte count and hemoglobin concentration of the five cases post-treatment merely increased to the lower end of the normal range. Platelet count returned to the normal range, increasing by 466%, 378%, 252%, 168% and 35%, respectively. There were four to five B-cell antigenic determinants along pLDH peptide chains of the infected strains in the five cases. Of them, the four sequences of 63th ~70th aa, 86th ~96th aa, 198th ~207th aa, 287th ~295th were commonly found on pLDH peptide chains from Plasmodium vivax, Plasmodium falciparum and Plasmodium malariea strains. Of note, the sequence of “211-EEVEGIFDR-220" was only detected in Plasmodium vivax strain, whereas the sequence of “207-LISDAE-213” was unique for Plasmodium falciparum strain. The spatial location of both two sequences were proximal to the “fusion region" of antigenic epitopes on the surface of pLDH tetramer. Conclusion Examination of the Plasmodium infection in Bone marrow puncture fluid could make up for the missed diagnosis of malaria that solely relies on peripheral blood examination. For patients who travelled to malaria-endemic areas without common pathogenic microbial infections, yet with hepatosplenomegaly, granulocytic myelosuppression, decreased platelet counts, low level of hemoglobin and suspicious pLDH antigen results, bone marrow puncture can be applied to confirm the diagnosis of malaria more accurately.

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“…Indeed recent work with P. vivax in splenectomised rhesus macaques demonstrated those spaces of bone marrow as the dominant compartment of that infection [6]. Plasmodium falciparum has also been shown to interact with bone marrow; employing it as a site of maturation and for evasion of the host immune response [7][8][9][10][11][12]. The anaemia that often develops with acute malaria involves bone marrow suppression and ineffective erythropoiesis [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Malarial parasites were rst demonstrated in the bone marrow on autopsies of lethal malaria cases in 1892, not long after the discovery of the malarial parasite [3]. Later, bone marrow aspiration was described as an accessory and useful tool in the diagnosis of malaria especially in cases where strong suspicion of malaria could not be con rmed on routine peripheral smears [8][9][10]. Peripheral smear examination under light microscopy remains the gold standard of malaria diagnosis and consistently negative ndings in a patient are considered de nitive.…”

Section: Introductionmentioning

confidence: 99%

Plasmodia in bone marrow examinations: Case series from a hospital in Pakistan 2007-2015

Shaikh¹,

Ali²,

Janjua³

et al. 2021

Preprint

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Background Malaria is a life-threatening, multisystem disease caused by the protozoan plasmodia with a global incidence of approximately 212 million annually. The parasite is known to have unique and crucial interactions with various body tissues during its life cycle, notably the liver, spleen, and recent work has shown the bone marrow as reservoir of infection.Methods This study is a case series of patients in whom examination of bone marrow revealed malaria parasites. We conducted a retrospective record review of 35 malaria-positive bone marrow specimens examined at Aga Khan University Hospital (AKUH), Karachi, Pakistan, over the years 2007 to 2015. Bone marrow aspirates were collected as per International Council for Standardization in Haematology (ICSH) guidelines.Results The median age of patients was 22 years (range 1–75), and 60% (n = 21) were male. 22 patients had evidence of P. falciparum, 12 had evidence of P. vivax and 1 patient had a mixed infection. Gametocytes and trophozoites were the most common stages identified on both peripheral blood and bone marrow examinations. Indications for bone marrow examination included fever of unknown origin and the workup of cytopenias and malignancies.Conclusions The incidental finding of plasmodia in samples of bone marrow from our patients suggests the reticuloendothelial system may be regularly infected by these parasites, be it acute or chronic in character.

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The Diagnostic Value of Bone-Marrow Biopsy in Malaria Caused byPlasmodium Falciparum

Cited by 7 publications

References 5 publications

Plasmodium in the bone marrow: case series from a hospital in Pakistan, 2007–2015

Plasmodium in the bone marrow: case series from a hospital in Pakistan, 2007–2015

Examination of Plasmodium parasites in bone marrow puncture fluid for the diagnosis of imported malaria patients in Yunnan Province, China

Plasmodia in bone marrow examinations: Case series from a hospital in Pakistan 2007-2015

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