Page 170 - Medical Parasitology_ A Textbook ( PDFDrive )

14 Case Reports 163

of her blood film confirmed P. knowlesi mono- infection, and blood cultures done
on admission were negative.

Learning Points
1. The case highlights the need for close monitoring of the respiratory status of
patient even after the institution of anti-malarial treatment. ARDS with hypox-
emia can develop even with a decreasing parasite count. This may be more impor-
tant in severe knowlesi malaria where pulmonary complications are common.
2. Clinicians must be alert to the possibility of knowlesi malaria, particularly if a
history reveals recent activities in or near forested areas in Southeast Asia.

Source: Rajahram GS, Barber BE, Yeo TW, Tan WW, William T. Case report:
fatal Plasmodium knowlesi malaria following an atypical clinical presentation
and delayed diagnosis. Medical Journal of Malaysia 2013, 68(1):71–2.

Acknowledgement
We are grateful to Dr. Giri Shan Rajahram, Consultant Infectious Diseases
Physician, Hospital Queen Elizabeth II (Sabah Heart Centre), Kota Kinabalu,
Sabah, Malaysia for his contribution of these case reports.

Case 7: Imported Case of Plasmodium ovale Infection in Malaysia
Case report: A 20-year-old Nigerian male student who has been in Malaysia for the
last 6 months presented with a history of fever associated with chills and rigors for
the last 4 days. Other physical examination findings were unremarkable. Laboratory
findings on admission revealed anaemia (haemoglobin of 10.8 g/dL), platelet count
of 117,000/μL and eosinophils of 2%. Microscopy examination of thin blood smear
stained with Giemsa showed parasites resembling Plasmodium vivax with enlarged
infected red blood cells. However, PCR followed by sequencing confirmed the spe-
cies to be Plasmodium ovale. He was treated with quinine 600 mg tds and doxycy-
cline 100 mg bd. One week after admission, the patient was discharged well.

Source: Lim, Yvonne AL, Rohela Mahmud, Ching Hoong Chew, T. Thiruventhiran,
and Kek Heng Chua. “Plasmodium ovale infection in Malaysia: first imported
case.” Malaria Journal 9, no. 1 (2010): 272.

Learning Points
1. Plasmodium ovale should be considered as a differential diagnosis in febrile
patients from endemic regions (West Africa).
2. Although microscopy is the gold standard diagnostic test for malaria, molecular
techniques such as PCR is useful to confirm the causative Plasmodium species.
3. Primaquine should be added into the treatment regime in ovale malaria to pre-
vent relapse.