Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report
Abstract Background Plasmodium ovale malaria, which was previously endemic to tropical Africa and the Southwest Pacific islands is now being reported from parts of Asia. In Sri Lanka, the indigenous transmission of malaria has not been documented since October 2012. Since then, there have been sever...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-04226-z |
| _version_ | 1797388296301576192 |
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| author | Damsara Kularatne Pubudu Chulasiri Arinda Dharmapala Senanayake Kularatne |
| author_facet | Damsara Kularatne Pubudu Chulasiri Arinda Dharmapala Senanayake Kularatne |
| author_sort | Damsara Kularatne |
| collection | DOAJ |
| description | Abstract Background Plasmodium ovale malaria, which was previously endemic to tropical Africa and the Southwest Pacific islands is now being reported from parts of Asia. In Sri Lanka, the indigenous transmission of malaria has not been documented since October 2012. Since then, there have been several imported cases of malaria, including P. ovale, which have been detected sporadically. The reporting case of P. ovale was imported and detected incidentally in 2021, with several atypical presentations. Case presentation A 40-year-old Sri Lankan medical doctor developed continuous fever with chills, rigors, and dysuria a day following removal of a large lipoma at the root of the neck under general anaesthesia. When the fever has been responding to antibiotics, on the 4th postoperative day a mild thrombocytopenia on complete blood count was detected. A blood smear which was done on the 5th postoperative day incidentally found a malaria parasite and confirmed as Plasmodium ovale with a density of 6535 parasites/microliter on the same day. He never had malaria in the past, but he had worked in South Sudan 1 year ago and visited India six months ago. On the 6th postoperative day, he was treated with chloroquine, and hyperparasitemia reduced rapidly by the next day. As the fever recurred with clinical deterioration, he was treated with different antibiotics. During the course of the illness, he did not develop pallor, or icterus except for a palpable soft spleen. The parasite count was zero on the 9th postoperative day and his fever subsided on the next day. Further, he was treated with primaquine to prevent future relapse and transmission. Conclusion A long incubation period, incidental detection of P ovale in a blood smear, and hyperparasitaemia are the atypical presentations of this case. Postoperative bacterial infection and stress may have reactivated the dormant malaria (hyponozoites) in this patient with an unusual picture. Coinfection of malaria with bacterial sepsis is a challenge in the management of the patient. As the Anopheles mosquito vector exists in Sri Lanka, the risk of indigenous transmission is high from such imported cases of P. ovale. |
| first_indexed | 2024-03-08T22:38:47Z |
| format | Article |
| id | doaj.art-ced2b23c68234eb6b4e6696eb592d228 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-08T22:38:47Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-ced2b23c68234eb6b4e6696eb592d2282023-12-17T12:18:55ZengBMCJournal of Medical Case Reports1752-19472023-12-011711710.1186/s13256-023-04226-zPlasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case reportDamsara Kularatne0Pubudu Chulasiri1Arinda Dharmapala2Senanayake Kularatne3Center for Research in Tropical Medicine, Faculty of Medicine, University of PeradeniyaAnti Malaria Campaign, Ministry of HealthDepartment of Surgery, Faculty of Medicine, University of PeradeniyaDepartment of Medicine, Faculty of Medicine, University of Sri LankaAbstract Background Plasmodium ovale malaria, which was previously endemic to tropical Africa and the Southwest Pacific islands is now being reported from parts of Asia. In Sri Lanka, the indigenous transmission of malaria has not been documented since October 2012. Since then, there have been several imported cases of malaria, including P. ovale, which have been detected sporadically. The reporting case of P. ovale was imported and detected incidentally in 2021, with several atypical presentations. Case presentation A 40-year-old Sri Lankan medical doctor developed continuous fever with chills, rigors, and dysuria a day following removal of a large lipoma at the root of the neck under general anaesthesia. When the fever has been responding to antibiotics, on the 4th postoperative day a mild thrombocytopenia on complete blood count was detected. A blood smear which was done on the 5th postoperative day incidentally found a malaria parasite and confirmed as Plasmodium ovale with a density of 6535 parasites/microliter on the same day. He never had malaria in the past, but he had worked in South Sudan 1 year ago and visited India six months ago. On the 6th postoperative day, he was treated with chloroquine, and hyperparasitemia reduced rapidly by the next day. As the fever recurred with clinical deterioration, he was treated with different antibiotics. During the course of the illness, he did not develop pallor, or icterus except for a palpable soft spleen. The parasite count was zero on the 9th postoperative day and his fever subsided on the next day. Further, he was treated with primaquine to prevent future relapse and transmission. Conclusion A long incubation period, incidental detection of P ovale in a blood smear, and hyperparasitaemia are the atypical presentations of this case. Postoperative bacterial infection and stress may have reactivated the dormant malaria (hyponozoites) in this patient with an unusual picture. Coinfection of malaria with bacterial sepsis is a challenge in the management of the patient. As the Anopheles mosquito vector exists in Sri Lanka, the risk of indigenous transmission is high from such imported cases of P. ovale.https://doi.org/10.1186/s13256-023-04226-zCase reportPlasmodium ovale malariaBacterial co-infectionHyperparasitaemiaAnopheles mosquitoIndia |
| spellingShingle | Damsara Kularatne Pubudu Chulasiri Arinda Dharmapala Senanayake Kularatne Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report Journal of Medical Case Reports Case report Plasmodium ovale malaria Bacterial co-infection Hyperparasitaemia Anopheles mosquito India |
| title | Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report |
| title_full | Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report |
| title_fullStr | Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report |
| title_full_unstemmed | Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report |
| title_short | Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report |
| title_sort | plasmodium ovale infection in sri lanka distant exposure and incidental detection of hyperparasitemia a case report |
| topic | Case report Plasmodium ovale malaria Bacterial co-infection Hyperparasitaemia Anopheles mosquito India |
| url | https://doi.org/10.1186/s13256-023-04226-z |
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