Hyposplenism revealed by Plasmodium malariae infection

Benjamin Hommel,Pierre Buffet,Alexandre Galloula,Anne Simon

doi:10.1186/1475-2875-12-271

Benjamin Hommel, Pierre Buffet + Show 2 more

Open Access

https://doi.org/10.1186/1475-2875-12-271

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Abstract

BackgroundHyposplenism, due to splenectomy, inherited red blood cell disorders or acquired conditions such as celiac disease, has an important impact on the severity of malaria, especially in non-immune patients. Conversely, that malaria may reveal functional hyposplenism has not been described previously.MethodsA 31-year old gardener was diagnosed with an uncomplicated attack of Plasmodium malariae 11 years after leaving the endemic area. In addition to trophozoites and schizonts, thick and thin smears also showed Howell-Jolly bodies, pointing to functional hyposplenism. This was later confirmed by the presence of a calcified spleen in the context of S/β + sickle-cell syndrome in a patient previously unaware of this condition.ConclusionMalaria may reveal hyposplenism. Although Howell-Jolly bodies are morphologically similar to nuclei of young Plasmodium trophozoite, distinction on smears is based on the absence of cytoplasm and irregular size of Howell-Jolly bodies. In the patient reported here, hyposplenism was revealed by the occurrence of P. malariae infection relatively late in life. Timely diagnosis of hyposplenism resulted in the implementation of appropriate measures to prevent overwhelming infection with capsulated bacteria. This observation highlights the importance of diagnosing hyposplenism in patients with malaria despite the morphological similarities between ring nuclei and Howell-Jolly bodies on thick smears.

Highlights

Hyposplenism, due to splenectomy, inherited red blood cell disorders or acquired conditions such as celiac disease, has an important impact on the severity of malaria, especially in non-immune patients
The rosette-like aspect of a schizont (Figure 1A), the small size of the erythrocyte-hosting gametocytes on the thin smear (Figure 1B) and the absence of Maurer or Schüffner dots were highly suggestive of P. malariae infection, latter confirmed by a positive polymerase chain reaction with primers specific for P. malariae [5]
This evolution is almost constant in adult patients with homozygous sickle cell disease but is less frequent in patients with the S/β + sickle cell syndrome [11]

Summary

Methods

The rosette-like aspect of a schizont (Figure 1A), the small size of the erythrocyte-hosting gametocytes on the thin smear (Figure 1B) and the absence of Maurer or Schüffner dots were highly suggestive of P. malariae infection, latter confirmed by a positive polymerase chain reaction with primers specific for P. malariae [5]. This diagnosis was consistent with the very long incubation period and the rhythm of fever. Malaria prophylaxis was recommended in case of travel to Africa

Conclusion

Background

15. Luzzatto L

Findings

18. Toma E