Spontaneous splenic rupture in Plasmodium knowlesi malaria
Spontaneous splenic rupture in Plasmodium knowlesi malaria
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DOI：
10.1186/s12936-018-2600-2
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发表时间：
2018-12-04
期刊：
影响因子：
3
通讯作者：
Singh, Balbir
中科院分区：
文献类型：
--
作者：
Chang, Chee Yik;Pui, Wei Chieng;Singh, Balbir
背景诺氏疟原虫是一种疟疾寄生虫，通常存在于长尾猕猴和猪尾猕猴中，是马来西亚婆罗洲人类疟疾的最常见原因。人类感染会导致一系列疾病，包括致命的后果。自发性脾破裂是一种罕见但严重的疟疾并发症，以前没有关于诺氏疟疾的报道。病例介绍一名 46 岁男性因发烧和急腹症，并伴有诺氏疟原虫感染而在 Kapit 医院就诊。到达医院后，他处于代偿性休克状态。他有全身腹部压痛，上腹部压痛最严重。床边聚焦腹部超声检查显示腹部有游离液体。鉴于血流动力学不稳定和腹膜炎恶化，他接受了紧急剖腹探查术。术中发现腹腔积血和脾脏出血。进行了脾切除术。组织病理学检查结果提示脾破裂和疟疾色素的存在。通过巢式 PCR 检测对他的血液样本进行分析，证实诺氏疟原虫感染。患者完成了一个疗程的抗疟治疗，术后恢复良好。结论自发性脾破裂是疟疾罕见的并发症。这是首例报道诺氏疟原虫疟疾感染导致脾破裂的病例。检测这种并发症需要高度的临床怀疑，并且在资源有限的医院中极具挑战性。
BackgroundPlasmodium knowlesi, a malaria parasite typically found in long-tailed and pig-tailed macaques, is the most common cause of human malaria in Malaysian Borneo. Infections in humans result in a spectrum of disease, including fatal outcomes. Spontaneous splenic rupture is a rare, but severe complication of malaria and has not been reported previously for knowlesi malaria.Case presentationA 46-year-old man presented with fever and acute surgical abdomen with concomitant P. knowlesi malaria infection at Kapit Hospital. He was in compensated shock upon arrival to the hospital. He had generalized abdominal tenderness, maximal at the epigastric region. Bedside focused abdominal ultrasonography revealed free fluid in the abdomen. He underwent emergency exploratory laparotomy in view of haemodynamic instability and worsening peritonism. Intraoperatively, haemoperitoneum and bleeding from the spleen was noted. Splenectomy was performed. Histopathological examination findings were suggestive of splenic rupture and presence of malarial pigment. Analysis of his blood sample by nested PCR assays confirmed P. knowlesi infection. The patient completed a course of anti-malarial treatment and recovered well post-operation.ConclusionsSpontaneous splenic rupture is a rare complication of malaria. This is the first reported case of splenic rupture in P. knowlesi malaria infection. Detection of such a complication requires high index of clinical suspicion and is extremely challenging in hospitals with limited resources.