Abstract
The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007-November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1-2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.
Highlights
The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown
In recent years at Queen Elizabeth Hospital (QEH), a tertiary care referral hospital in Kota Kinabalu, Sabah State, patients with severe malaria by World Health Organization (WHO) criteria had received a diagnosis by microscopy as P. malariae infection, but P. knowlesi was suspected as the etiologic agent
On the basis of WHO severity criteria [22], 22 (39%) had severe malaria, and 34 (61%) had uncomplicated disease (Figure). These patients were identified from a group of 74 patients with documented P. malariae malaria listed in the laboratory microscopy register: 54 had P. knowlesi monoinfection shown by PCR and medical records available for review (Figure)
Summary
The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007–November 2009 at a tertiary care hospital in Sabah, Malaysia. The first description of naturally acquired severe human P. knowlesi infection was a retrospective study from Sarawak that detailed 4 fatal cases with multiorgan failure [17]. In recent years at Queen Elizabeth Hospital (QEH), a tertiary care referral hospital in Kota Kinabalu, Sabah State, patients with severe malaria by WHO criteria had received a diagnosis by microscopy as P. malariae infection, but P. knowlesi was suspected as the etiologic agent. We. Severe P. knowlesi Malaria conducted a retrospective review of the clinical spectrum of all case-patients with P. malariae malaria who were admitted to QEH during December 2007–November 2009 and confirmed the diagnosis of P. malariae or P. knowlesi infection by molecular methods
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
