Abstract
BackgroundThere is a high prevalence of malaria and viral hepatitis in South Africa. Co-infection with Plasmodium malaria (leading to cerebral malaria) and hepatitis E virus (HEV) is a rare phenomenon.Case presentationA 33-year-old African American male with no past medical history developed altered mental status on his return from Ivory Coast. His blood tests were significant for renal and liver failure and a high Plasmodium parasite burden of 33% on the blood smear. Interestingly, he also had a positive result for hepatitis E IgM. The patient was effectively treated with aggressive hydration and intravenous (IV) artesunate.ConclusionOur report is the first to our knowledge in the cerebral malaria literature on a patient with hepatitis E co-infection. This exciting case emphasizes the importance of considering all kinds of endemic infectious diseases when evaluating sick returning travelers presenting to the emergency department.
Highlights
Plasmodium malaria, a mosquito-borne parasitic disease, has been known to humankind since early times
We report an unusual case of a co-infection of hepatitis E in a patient who developed cerebral malaria from Plasmodium falciparum infection [10]
Transaminitis and hyperbilirubinemia should raise the suspicion of potential endemic infections, such as malaria and viral hepatitis [27]
Summary
Malaria and viral hepatitis are not the first thought in a physician’s mind when a patient comes in with vague complaints in an emergency room in a first world country. The suspicion of malaria and hepatitis should be high in patients with a recent travel history to endemic areas, South Africa and South Asia. Transaminitis and hyperbilirubinemia should raise the suspicion of potential endemic infections, such as malaria and viral hepatitis [27]. We propose that transaminitis should always trigger testing for peripheral blood smears and an acute hepatitis panel in sick returning travelers. Timely detection and treatment saved this lucky patient from any neurological deficits, which is always a potential complication of cerebral malaria as discussed above. These patients should be closely monitored as outpatients after discharge. Abbreviations E.R.: Emergency room; IV: Intravenous; ARDS: Acute respiratory distress syndrome; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CDC: Centers for Disease Control and Prevention; CSF: Cerebrospinal fluid; GCS: Glasgow coma scale; PCR: Polymerase chain reaction
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