Uncommon Manifestation of a Mixed‐Species Malaria Infection: Cryptic Falciparum Malaria in a Traveler With Successfully Treated Tertian Malaria

Menner, Nikolai; Borchert, Matthias; Dieckmann, Sebastian; Ignatius, Ralf; Mockenhaupt, Frank P.

doi:10.1111/j.1708-8305.2011.00595.x

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…The timing of infection, variability of hypnozoite phase duration, interactions between species and other factors may play a role. A recent case report described a mixed-species infection where the patient presented first with P. ovale malaria with a subsequent delayed presentation of P. falciparum [7]. …”

Section: Discussionmentioning

confidence: 99%

Mixed-species Plasmodium falciparum and Plasmodium ovale malaria in a paediatric returned traveller

Senn

Alattas

Boggild

et al. 2014

Malar J

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Malaria is a common and potentially fatal cause of febrile illness in returned travellers. Endemic areas for different malaria parasites overlap, but mixed species infections are rare. An adolescent male returned from a trip to Ghana in late summer 2013. He subsequently presented with blood smears positive for two species of malaria parasite, Plasmodium falciparum and Plasmodium ovale, on two isolated hospital visits within a six-week period. The epidemiology of mixed infections, likely pathophysiology of his presentation, and the implications for malaria testing and treatment in returned travellers are discussed.

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Section: Discussionmentioning

confidence: 99%

Mixed-species Plasmodium falciparum and Plasmodium ovale malaria in a paediatric returned traveller

Senn

Alattas

Boggild

et al. 2014

Malar J

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“…Of 198 malaria-positive samples of children under 5 years old, 17.2% were positive for P. ovale in Democratic Republic of Congo 8. The other reason for the rarity of P. falciparum and P. ovale mixed infection is that P. ovale tends to be missed in mixed infections because of its low parasite density 9. To our knowledge, there have been four case reports to date that have described mixed-species malaria infections in Korea, all of which involved P. falciparum and P. vivax mixed infections10 - 13; thus, the case described here is the first reported case of P. falciparum and P. ovale mixed infection in Korea.…”

Section: Discussionmentioning

confidence: 99%

Mixed Infection withPlasmodium falciparumandPlasmodium ovalein a Returned Traveller: the First Case in Korea

et al. 2019

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Mixed-species malaria infections are often unrecognized or underestimated. We hereby report the first described case of mixed infection with Plasmodium falciparum and Plasmodium ovale malaria in a returned traveller in Korea. In August 2016, a 25-year-old returned traveller from Cameroon and Democratic Republic of Congo presented with fever. He was diagnosed as P. falciparum malaria and successfully treated with artesunate. And 5 weeks after the completion of treatment, he presented with fever and diagnosed as P. ovale infection. P. ovale infection is a rare cause of malaria and often shows delayed presentation due to its dormant liver stage as hypnozoites. At re-presentation, the immunochromatographic test and microscopic examinations of our patient did not reveal P. ovale, which was only detected via polymerase chain reaction (PCR) assay. This case highlights the importance of considering malaria infection even in persons who have previously received malaria treatment. It also shows the usefulness of PCR testing for diagnosing P. ovale infections, which often present with a low level of parasitaemia.

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“…Failure to recognize mixed infection by different Plasmodium species may lead to treatment failure. [121][122][123] The incidence of mixed Plasmodium species infection is around 2% based on microscopy. 120 Using molecular diagnostics, a much higher incidence of mixed infection was detected, with over 20% of the malaria cases being co-infections in some endemic areas.…”

Section: Mixed Infection Not Readily Discernible By Conventional Microscopymentioning

confidence: 99%

Molecular diagnosis in clinical parasitology: When and why?

Wong

Fung

Chau

et al. 2014

Exp Biol Med (Maywood)

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Microscopic detection and morphological identification of parasites from clinical specimens are the gold standards for the laboratory diagnosis of parasitic infections. The limitations of such diagnostic assays include insufficient sensitivity and operator dependence. Immunoassays for parasitic antigens are not available for most parasitic infections and have not significantly improved the sensitivity of laboratory detection. Advances in molecular detection by nucleic acid amplification may improve the detection in asymptomatic infections with low parasitic burden. Rapidly accumulating genomic data on parasites allow the design of polymerase chain reaction (PCR) primers directed towards multi-copy gene targets, such as the ribosomal and mitochondrial genes, which further improve the sensitivity. Parasitic cell or its free circulating parasitic DNA can be shed from parasites into blood and excreta which may allow its detection without the whole parasite being present within the portion of clinical sample used for DNA extraction. Multiplex nucleic acid amplification technology allows the simultaneous detection of many parasitic species within a single clinical specimen. In addition to improved sensitivity, nucleic acid amplification with sequencing can help to differentiate different parasitic species at different stages with similar morphology, detect and speciate parasites from fixed histopathological sections and identify anti-parasitic drug resistance. The use of consensus primer and PCR sequencing may even help to identify novel parasitic species. The key limitation of molecular detection is the technological expertise and expense which are usually lacking in the field setting at highly endemic areas. However, such tests can be useful for screening important parasitic infections in asymptomatic patients, donors or recipients coming from endemic areas in the settings of transfusion service or tertiary institutions with transplantation service. Such tests can also be used for monitoring these recipients or highly immunosuppressed patients, so that early preemptive treatment can be given for reactivated parasitic infections while the parasitic burden is still low.

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Uncommon Manifestation of a Mixed‐Species Malaria Infection: Cryptic Falciparum Malaria in a Traveler With Successfully Treated Tertian Malaria

Cited by 5 publications

References 11 publications

Mixed-species Plasmodium falciparum and Plasmodium ovale malaria in a paediatric returned traveller

Mixed-species Plasmodium falciparum and Plasmodium ovale malaria in a paediatric returned traveller

Mixed Infection withPlasmodium falciparumandPlasmodium ovalein a Returned Traveller: the First Case in Korea

Molecular diagnosis in clinical parasitology: When and why?

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