Korean J Parasitol.  2014 Dec;52(6):667-672. 10.3347/kjp.2014.52.6.667.

An Imported Case of Severe Falciparum Malaria with Prolonged Hemolytic Anemia Clinically Mimicking a Coinfection with Babesiosis

• Na YJ
• Chai JY
• Jung BK
• Lee HJ
• Song JY
• Je JH
• Seo JH
• Park SH
• Choi JS
• Kim MJ

• KMID: 2069818
• DOI: http://doi.org/10.3347/kjp.2014.52.6.667

Abstract

While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.

Keyword

Plasmodium falciparum; imported malaria; falciparum malaria; babesiosis; hemolytic anemia; artesunate

MeSH Terms

Anemia, Hemolytic/chemically induced/*etiology/*pathology
Anti-Bacterial Agents/therapeutic use
Antimalarials/therapeutic use
Artemisinins/adverse effects/therapeutic use
Atovaquone/therapeutic use
Azithromycin/therapeutic use
Babesiosis/complications/*diagnosis/drug therapy/*pathology
Benin
Blood/parasitology
Coinfection/diagnosis/pathology
Drug Combinations
France
Humans
Korea
Malaria, Falciparum/complications/*diagnosis/drug therapy/*pathology
Male
Middle Aged
Plasmodium falciparum/*isolation & purification
Proguanil/therapeutic use
Travel
Treatment Outcome
Anti-Bacterial Agents
Antimalarials
Artemisinins
Atovaquone
Azithromycin
Drug Combinations
Proguanil