Abstract
BackgroundPlasmodium malariae is the cause of the rare but severe form of malaria that sometimes affects individuals travelling to malaria-endemic regions. This report presents the unique case of a patient exhibiting severe malaria symptoms caused by P. malariae with no record of recent travel to any malaria-endemic areas.Case presentationAn 81-year-old French woman was admitted to the emergency department with sustained fever and severe weakness for the past 5 days. She suffered from anaemia, thrombocytopenia, confusion, somnolence, pulmonary complications, and hypoxaemia. In the absence of any concrete aetiology that could explain the fever together with thrombocytopenia, physicians suspected malaria as a probable diagnosis.The LAMP-PCR and lateral flow test confirmed the presence of malaria parasite, Plasmodium sp. Microscopic examination (May-Grünwald Giemsa-stained thin blood smear) revealed the presence of trophozoites, schizonts, and gametocytes with 0.93 % parasitaemia. Conventional PCR amplification targeting 510 bp DNA fragment of small subunit ribosomal RNA (ssrRNA) and bidirectional sequencing identified the parasite as Plasmodium malariae. The travel history of this patient revealed her visits to several countries in Europe (Greece), North Africa (Tunisia and Morocco), and the West Indies (Dominican Republic). Of these, the latter was the only country known to be endemic for malaria at the time (three malaria parasite species were prevalent: Plasmodium falciparum, Plasmodium vivax, and P. malariae). The patient had most likely got infected when she visited the Dominican Republic in the summer of 2002. This time interval between the initial parasite infection (2002) till the onset of symptoms and its subsequent diagnosis (2020) is a reminder of the ability of P. malariae to persist in the human host for many years.ConclusionsThis report highlights the persistent nature and ability of P. malariae to cause severe infection in the host even after a prolonged time interval.
Highlights
Plasmodium malariae is the cause of the rare but severe form of malaria that sometimes affects individuals travelling to malaria-endemic regions
Conventional PCR amplification targeting 510 bp DNA fragment of small subunit ribosomal RNA and bidirectional sequencing identified the parasite as Plasmodium malariae
The latter was the only country known to be endemic for malaria at the time
Summary
Malaria is a serious public health problem caused by Plasmodium spp that is transmitted by the bite of female Anopheles mosquitoes [1]. Plasmodium malariae usually causes a mild form of malaria prevalent in some parts of Africa, South America, Asia, and the Western Pacific [10,11,12,13] It has the longest incubation period among all Plasmodium species, ranging between 18 and 40 days, which sometimes even last for several years [14]. Case presentation On June 3rd, 2020, an 81-year-old French woman was admitted to the emergency department of a Paris hospital, for continuous fever and severe weakness for 5 days. On arrival, she had a mild fever (38.5 °C). The MGG-stained thick blood smears were examined on day 3 and day 7, after being shifted from ICU to a general ward, and a favourable evolution was observed within 5 days, with negative microscopy on d7
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