1/217. splenic rupture as a complication of P. falciparum malaria after residence in the tropics. Report of two cases. splenic rupture is an uncommon complication of malaria, which requires urgent medical investigation, close follow-up and adequate treatment. Until present, this complication was reported more often in P. vivax infections than in infections with other species. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The diagnosis is made by physical examination, ultrasound and CT-scan. Especially in malaria endemic areas the management of splenic rupture in malaria should be focused on splenic preservation. We describe two cases of splenic rupture during a P. falciparum infection, both requiring finally splenectomy. ( info) |
2/217. Case report: French west indies - a tourist destination at risk for plasmodium falciparum transmission? We report a case of P. falciparum infection observed in paris and presumably acquired in guadeloupe, a French Caribbean island where malaria has been considered to be eradicated since 1970. ( info) |
3/217. Severe subconjunctival haemorrhage associated with malaria. PURPOSE: To describe a patient with sudden onset of subconjunctival haemorrhage related to malaria. methods: A case report. RESULTS: The patient, who had a history of malaria, had bilateral subconjunctival haemorrhages. General examination showed no abnormality except malaria. All signs of conjunctival haemorrhages resolved later. CONCLUSION: Ocular malaria should be considered in the differential diagnosis of subconjunctival haemorrhages. ( info) |
| There are special considerations when performing cardiopulmonary bypass (CPB) on a patient with malaria. A 70-year-old female with a recent history of severe aortic stenosis was scheduled to undergo elective aortic valve replacement. One week prior to surgery, the patient developed shaking chills and fever, with a positive malaria smear. An extensive literature search was undertaken to determine the effect of CPB on a patient with active malaria, but no prior reference was found. One major concern was the lysis of red blood cells while on bypass. The surgery was performed uneventfully, following 2 weeks of treatment with primaquine phosphate. ( info) |
| malaria is no longer endemic in puerto rico, however, imported cases of the disease are occasionally reported to the health Department of the Island. This is a report of a 45-year-old female patient who traveled to kenya and niger and was admitted to a San Juan area hospital with an 8 day history of daily chills and fever, myalgia, nausea and vomiting. Upon admission, peripheral blood displayed multiple intra-erythrocytic ring-shape trophozoites, highly suggestive of plasmodium falciparum. The polymerase chain reaction was used as a complementary method for the detection of malaria parasites and confirmation of post-treatment parasite clearance. This report presents an imported case of malaria in puerto rico and showed the use of a molecular technique to diagnose Plasmodium. ( info) |
6/217. malaria in the neonate: report of 2 cases. Two cases of neonatal malaria are reported, both presenting with signs similar to neonatal sepsis. The first baby responded to oral chloroquine (CQ) with fever and parasite clearance times of 48 h and 60 h respectively. The CQ treatment failed in the second baby and was subsequently treated successfully with oral Halofantrine hydrochloride. These cases indicate a need for routine blood film for malaria parasite as part of initial screening for neonatal sepsis. ( info) |
7/217. Post malaria cerebellar ataxia and ocular flutter: report of two cases. We report two cases of post malarial cerebellar ataxia presenting with severe ocular flutter, in a female of 72 years and a male of 20 years. Both patients had falciparum malaria infection. CT scans of both patients were within normal limits for the age. Cerebellar signs as well as ocular flutter responded very well to moderate doses of prednisolone therapy. ( info) |
8/217. A case series of falciparum malaria-induced acute renal failure. Falciparum malaria is a disease of tropical climates which affects 270 million people annually and has an overall mortality of 1%. While the incidence of acute renal failure in malaria is less than 1%, mortality is reported to be as high as 45% in those with renal failure. We report the clinical course and outcome in 5 patients with falciparum malaria-induced acute renal failure treated at the singapore General Hospital between June and July 1997. All 5 males, with mean age of 35.2 /- 13.1 years, were admitted with history of fever and reported travel to a known malarious zone. Mean laboratory parameters upon admission included serum creatinine 725 /- 515 mumol/L and serum urea 47 /- 31 mmol/L. Three patients with hypotension on admission were started on haemodiafiltration, of whom 2 were subsequently converted to haemodialysis as their haemodynamics improved. Two remaining patients were started on intermittent bicarbonate haemodialysis. The overall mortality in our series was 20%, with 1 patient having died of complications of adult respiratory distress syndrome, disseminated intravascular coagulation and multiorgan failure. The remaining 4 survived and recovered their renal function. The single patient mortality occurred in the patient with admission serum creatinine of 1632 mumol/L, a value significantly higher than that of the 4 patients who survived (mean serum creatinine, 499 /- 106 mumol/L, P < 0.002). These results suggest that falciparum malaria associated with acute renal failure is associated with a high morbidity, but early presentation and intervention with appropriate antimalarial and renal replacement therapy is associated with improved survival and recovery of renal function. ( info) |
| Recently fully automated methods for enumerating reticulocytes have become available as an integral function in routine haematology analysers. In such methods, all intraerythrocytic nucleic acid is stained and can be regarded as representing reticulocytes. It has previously been shown that Howell-Jolly bodies may be counted as reticulocytes in automated flow cytometric methods. In the present paper, data from two patients are described indicating that severe malaria infection may lead to falsely increased reticulocyte counts, at least in the CELL-DYN(R) 4000 haematology analyser. In this instrument, the intraerythrocytic nuclear material of the parasites will be stained and counted as reticulocytes. This phenomenon appears to be independent of the type of Plasmodium infection. Clinical haematology laboratories should be aware of this potential source of pseudo-reticulocytosis. ( info) |
| Delay or failure in diagnostic or therapeutic management of Plasmodiumfalciparum malaria may result in avoidable deaths, often incurring medicolegal procedures. Advanced postmortem autolytic processes and putrefication may thwart malaria diagnosis by traditional microscopic and histologic examinations. The authors describe the usefulness of polymerase chain reaction to confirm postmortem diagnosis of malaria. ( info) |