Abstract
During the last two decades human infections with Plasmodium knowlesi are increasingly diagnosed in South East Asia and have also been reported in travellers. A severe case of imported P. knowlesi infection in a 73-year old German is presented, who had been travelling through Myanmar and Thailand for three weeks. Microscopy showed a parasitaemia of 3% and different parasite stages including band-forms resembling Plasmodium malariae. Due to the clinical picture of severe malaria and the microscopical aspect (combination of parasites resembling P. malariae and Plasmodium falciparum), P. knowlesi was suspected. The patient was treated with intravenous quinine; he was put on mechanical ventilation and catecholamines due to cardiorespiratory failure. Parasitaemia was cleared rapidly but renal function deteriorated resulting in intermittent haemodialysis. The patient was hospitalized for six weeks but he recovered completely without any physical sequelae. Plasmodium knowlesi mono-infection was confirmed by molecular methods later on.Plasmodium knowlesi infection has to be taken into account in feverish travellers returning from Thailand/Myanmar. Moreover this species can cause life-threatening or even lethal complications. Accordingly severe P. knowlesi infection should be treated like severe P. falciparum infections.
Highlights
A severe case of Plasmodium knowlesi infection in a 73year old man who had been travelling three weeks through Burma and southern Thailand in November/December 2013 is described.According to published cases, this is the third imported infection with P. knowlesi to Germany and the most severe described so far
Plasmodium knowlesi infection was, suspected and therapy started with intravenous quinine in combination with doxycycline (200 mg per day) immediately upon arrival at the intensive care unit (ICU) of Schwabing hospital
Initial suspicion of a P. knowlesi infection was based on the detection of intra-erythrocytic ring forms which resembled P. falciparum as well as band forms and schizonts indistinguishable from P. malariae in the patient’s thin blood smear
Summary
A severe case of Plasmodium knowlesi infection in a 73year old man who had been travelling three weeks through Burma and southern Thailand in November/December 2013 is described. Case presentation The 73-year old German patient had been travelling in December 2013 for three weeks for diving and rainforest excursions; he visited the island of Mecleod (Myanmar) and in Thailand Khura Buri, the island Koh Ra, Khao Lak, and Phuket The day after his return, he developed high fever and chills. Plasmodium knowlesi infection was, suspected and therapy started with intravenous quinine (due to the lack of artesunate at the time of diagnosis) in combination with doxycycline (200 mg per day) immediately upon arrival at the intensive care unit (ICU) of Schwabing hospital. The severe course of the disease with malaria-related lung and kidney failure was likely due to delayed medical presentation by the patient and diagnosis could only be established seven days after onset of symptoms. Written informed consent of the patient was procured for publication
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