Abstract
Plasmodium knowlesi can cause severe malaria in adults; however, descriptions of clinical disease in children are lacking. We reviewed case records of children (age <15 years) with a malaria diagnosis at Kudat District Hospital, serving a largely deforested area of Sabah, Malaysia, during January–November 2009. Sixteen children with PCR-confirmed P. knowlesi monoinfection were compared with 14 children with P. falciparum monoinfection diagnosed by microscopy or PCR. Four children with knowlesi malaria had a hemoglobin level at admission of <10.0 g/dL (minimum lowest level 6.4 g/dL). Minimum level platelet counts were lower in knowlesi than in falciparum malaria (median 76,500/µL vs. 156,000/μL; p = 0.01). Most (81%) children with P. knowlesi malaria received chloroquine and primaquine; median parasite clearance time was 2 days (range 1–5 days). P. knowlesi is the most common cause of childhood malaria in Kudat. Although infection is generally uncomplicated, anemia is common and thrombocytopenia universal. Transmission dynamics in this region require additional investigation.
Highlights
Plasmodium knowlesi can cause severe malaria in adults; descriptions of clinical disease in children are lacking
The clinical and laboratory features of P. knowlesi infections in adults have been described in Kapit, Sarawak, where 107 (70%) of 152 adults with malaria were infected with P. knowlesi [3]
Microscopy results were used if PCR result was negative (5 P. knowlesi infections and 1 P. knowlesi/P. falciparum infection) or if PCR result was positive for Plasmodium spp
Summary
Plasmodium knowlesi can cause severe malaria in adults; descriptions of clinical disease in children are lacking. All previously reported P. knowlesi infections that caused clinical disease have been in adults [1,2,6,8,11,12,13,15,18,19,20]. In malaria caused by P. falciparum [21] and P. vivax [22], the 2 species that cause the greatest number of human malaria cases, well-described differences exist between adults and children in terms of the clinical epidemiology, disease spectrum, and laboratory manifestations of disease. Clinical, and laboratory features of P. knowlesi infection in children in Kudat, Sabah, a rural coastal farming area with little remaining primary rainforest, an epidemiologic setting that contrasts with the previously described forested areas of Sarawak
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