Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report.
Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report.
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DOI：
10.1186/1475-2875-9-10
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发表时间：
2010-01-11
期刊：
影响因子：
3
通讯作者：
Krishna S
中科院分区：
文献类型：
--
作者：
Cox-Singh J;Hiu J;Lucas SB;Divis PC;Zulkarnaen M;Chandran P;Wong KT;Adem P;Zaki SR;Singh B;Krishna S
由诺氏疟原虫引起的人畜共患疟疾是一种重要的，但最近才被认识到的人类病原体。这里首次报道了一例致死性诺氏疟疾病例的尸检结果。一名以前健康的40岁男性在北婆罗洲丛林中度过10天后出现症状。四天后，他在崩溃状态下被送往医院，并在两小时内死亡。他出现低钠血症，血尿素、钾、乳酸脱氢酶和氨基转移酶值升高;他还出现血小板减少和嗜酸性粒细胞增多。怀疑为登革热出血性休克，并进行了尸检。对登革热病毒的调查呈阴性。疟疾寄生虫的血液指示高寄生虫血症，并且通过巢式PCR证实了单一物种诺氏疟原虫感染。脑和内皮细胞的肉眼病理学显示多处点状出血，肝脏和脾脏肿大，肺部具有与ARDS一致的特征。显微镜病理学显示，色素寄生红细胞在大脑、小脑、心脏和肾脏的血管中隔离，在大脑或任何其他检查器官中没有慢性炎症反应的证据。脑切片细胞内粘附分子-1呈阴性。脾脏和肝脏有丰富的含色素的巨噬细胞和寄生的红细胞。肾脏有急性肾小管坏死的证据，心脏切片中的内皮细胞明显。这一病例的总体情况是符合世卫组织严重疟疾分类的系统性疟疾感染。这个病例的尸检结果出乎意料地与那些定义致命恶性疟疾的结果相似，包括大脑病理学。有重要的差异，包括昏迷的情况下，尽管脑内的点状出血和寄生虫隔离。这些结果表明，对诺氏疟疾的进一步研究将有助于解释人类疟疾病理生理学的信息，这些信息往往是相互矛盾的。
Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria will aid the interpretation of, often conflicting, information on malaria pathophysiology in humans.
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DOI：
10.1086/510756
发表时间：
2007-02-15
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Anstey NM;Handojo T;Pain MC;Kenangalem E;Tjitra E;Price RN;Maguire GP
通讯作者：
Maguire GP
影响因子：
2.4
作者：
LANGHORNE, J;COHEN, S
通讯作者：
COHEN, S
影响因子：
6.4
作者：
Kremsner, Peter Gottfried;Valim, Clarissa;Taylor, Terrie
通讯作者：
Taylor, Terrie
影响因子：
3.8
作者：
Deshpande, P;Shastry, P
通讯作者：
Shastry, P
与严重的儿童疟疾相关的恶性疟原虫优先表达由A组VAR基因编码的PFEMP1。
影响因子：
15.3
作者：
Jensen, ATR;Magistrado, P;Sharp, S;Joergensen, L;Lavstsen, T;Chiucciuini, A;Salanti, A;Vestergaard, LS;Lusingu, JP;Hermsen, R;Sauerwein, R;Christensen, J;Nielsen, MA;Hviid, L;Sutherland, C;Staalsoe, T;Theander, TG
通讯作者：
Theander, TG