Abstract
A case of Plasmodium knowlesi and HIV co-infection is reported in a German traveller returning from Thailand. The 54 year-old patient presented to the Institute of Tropical Medicine in Tübingen with a 11-day history of daily fever and chills. Initial microscopic evaluation of Giemsa-stained thin blood smears was suggestive of a mixed infection with Plasmodium falciparum and Plasmodium malariae. However, PCR amplification of small subunit ribosomal RNA gene revealed a P. knowlesi infection. Parasitaemia was 473 parasites/μl and the platelet count was within the normal range. Oral treatment with Malarone® was initiated and resulted in a fast recovery without any complications.As part of routine screening the patient also underwent HIV testing and was found to be HIV positive with a CD4 cell count of 115/μl and a viral load of 34,799 copies/ml. A follow-up measurement of the viral load seven days after the first quantification revealed an increase to 102,000 copies/ml. Three months after the first quantification the viral load had dropped to 10,000 copies/ml without the initiation of antiretroviral treatment. This suggests the possibility of a P. knowlesi malaria-induced temporary elevation of viral load similar to that reported for P. falciparum and HIV co-infection.
Highlights
In the last eight years a growing body of literature confirmed the existence of a fifth species of Plasmodium capable of causing human malaria
Plasmodium knowlesi cases have been detected in several regions of Thailand mainly in forestal areas bordering Cambodia in the east, Malaysia in the south and Myanmar in the north-west [10]
A recent study confirmed the transmission of P. knowlesi in Ranong Province [38], where the here presented patient stayed for three days and where he most likely acquired the infection
Summary
In the last eight years a growing body of literature confirmed the existence of a fifth species of Plasmodium capable of causing human malaria. It has been reported that HIV infection increases the susceptibility to malaria [28,29] and the risk of developing severe Plasmodium falciparum malaria [30,31,32,33]. The interactions between malaria and HIV have been studied mainly in African countries with P. falciparum-infected patients. There is currently no published information about P. knowlesi malaria and HIV co-infection available.
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