Infect Chemother.  2012 Oct;44(5):386-390. 10.3947/ic.2012.44.5.386.

A Case of Mixed Malaria Infection with Severe Hemolytic Anemia after Travel to Angola

• Shin SY
• Yu JH
• Kim JY
• Kim YJ
• Woo HY
• Kwon MJ
• Yeom JS

• KMID: 2170385
• DOI: http://doi.org/10.3947/ic.2012.44.5.386

Abstract

In Korea, Plasmodium vivax (P. vivax) is the most common agent of malaria infection. However, as travel to regions where malaria is endemic increases, so do the numbers of Plasmodium falciparum and mixed infections. P. falciparum predominates, while P. vivax is rare in west-central Africa. We report on a case of mixed malaria infection with severe hemolytic anemia caused by P. falciparum and P. vivax in a 38-year-old man after traveling to Angola. A diagnosis of P. falciparum malaria was made by microscopic examination. However, both P. vivax and P. falciparum were detected by the polymerase chain reaction (PCR). As a radical cure P. vivax, the patient was treated with mefloquine, artemether, and primaquine. Both P. falciparum and P. vivax had disappeared from peripheral blood by admission day 4, however, low grade fever and headache persisted, and his hemoglobin and hematocrit levels were depleted. A peripheral blood smear was negative for both P. vivax and P. falciparum; however, a direct anti-globulin test and anti-nuclear antibody test were positive, suggesting immune hemolytic anemia. After conservative treatment, which included a transfusion with packed red blood cells (RBC), his symptoms and signs showed improvement and laboratory findings were normalized.

Keyword

Plasmodium falciparum; Plasmodium vivax; Mixed infection

MeSH Terms

Adult
Africa
Anemia, Hemolytic
Angola
Artemisinins
Coinfection
Erythrocytes
Fever
Headache
Hematocrit
Hemoglobins
Humans
Korea
Malaria
Mefloquine
Plasmodium falciparum
Plasmodium vivax
Polymerase Chain Reaction
Primaquine
Artemisinins
Hemoglobins
Mefloquine
Primaquine

Figure

• 

  Figure 1 Peripheral blood smears at first admission (Wright-Giemsa stain, ×400). (A) A ring-form of malaria parasites (marginal or appliqué appearance) with Maurer's dot indicates P. falciparum. (B) Two-ring form of malaria parasites are observed in one red blood cell.

• 

  Figure 2 Multiplex PCR for detection of malaria. The band of 205-bp indicates P. falciparum. The band of 120-bp indicates P. vivax. lane M, size marker; lane 1, negative control for P. falciparum; lane 2, negative control for P. vivax; lane 3, positive control for P. falciparum; lane 4, positive control for P. vivax; lane 5, patient specimen with primer for P. falciparum; lane 6, patient specimen with the primer for P. vivax.

• 

  Figure 3 Peripheral blood smear at second admission (Wright-Giemsa stain, ×1,000). Nucleated red blood cells are observed (arrow) and no malaria is visible.

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