1/12. Is there any artemisinin resistance in falciparum malaria?We reported two cases of complicated falciparum malaria who had poor response to artesunate with delayed parasite clearance times. They were splenectomized patients who were treated with high doses of artemisinin derivatives. Our cases showed the importance of the spleen in the clearance of malaria parasites and had different clinical outcome, one fatal and one recovery. The host factors, the parasitemia count, the quality of antimalarial chemotherapy and blood level of the antimalarial drugs must be considered in relation to the causes of the delayed clearance of parasitemia.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
2/12. Absence of knobs on parasitized red blood cells in a splenectomized patient in fatal falciparum malaria.We present a case report of fatal falciparum malaria of a splenectomized adult Thai patient. The patient developed high peripheral parasitemia and showed signs of severe malaria with multiorgans involvement. Ultrastructure of plasmodium falciparum-infected red blood cells in a fatal splenectomized patient and pathological features are reported for the first time with special emphasis on the role of the spleen as a modulating cytoadherence phenotype of parasitized red blood cells (PRBC). In this patient, adherence of the PRBC to the vascular endothelium of brain, kidney and lung including blood circulating cells, was noted, despite the absence of knob on the surface of the PRBC.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
3/12. Imported malaria in a Japanese male: an autopsy report.Fatal cases of malaria are rare in japan. We report a case of a 47-year-old Japanese man with plasmodium falciparum malaria. The patient was examined because of fever and headache after a trip to africa. He was diagnosed with malaria. Chemotherapy begun on day three decreased the percentage of infected red blood cells (RBC) from 25% to 2%, but the patient fell into coma on the same day. The patient was considered brain dead for 3 days before he died, and he was autopsied on day nine. brain hemispheres were preserved and swollen with meningeal congestion. The ventral area of the pons and medulla oblongata were softened, and the tonsils of the cerebellum were softened and herniated. The spleen was blackish, enlarged and showed a small infarction. The liver was yellowish and enlarged. Many infected RBC were seen in the capillaries of the brain and malaria pigments were seen in the spleen and liver. dna of P. falciparum was detected by polymerase chain reaction from paraffin-embedded brain materials, however, the dna could not be detected in other organs. Besides malaria, the patient had latent primary thyroid cancer, which was a small and invasive papillary carcinoma.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
4/12. Nonoperative treatment of splenic rupture in malaria tropica: review of literature and case report.In many parts of the world malaria still is a major medical problem. Heavy international and transcontinental traveling carries malaria to non-endemic areas. Practicing physicians must be aware of the common, but also the rare and severe complications of malaria. During malaria changes in splenic structure can result in asymptomatic enlargement or complications such as hematoma formation, rupture, hypersplenism, ectopic spleen, torsion, or cyst formation. An abnormal immunological response may result in massive splenic enlargement. Spontaneous rupture of the spleen is an important and life threatening complication of plasmodium vivax infection, but is rarely seen in plasmodium falciparum malaria. The ability to properly diagnose and manage these complications is important. spleen-conserving procedures should be the standard whenever possible especially in patients with a high likelihood of future exposure to malaria.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
5/12. Spontaneous rupture of spleen in falciparum malaria.Spontaneous rupture of spleen is an extremely rare complication of falciparum malaria. We report a 3 1/2-year-old girl with splenic rupture who was managed successfully with splenectomy and antimalarials.- - - - - - - - - - ranking = 5keywords = spleen (Clic here for more details about this article) |
6/12. Reduction of spleen size in a child with hyperreactive malarious splenomegaly (HMS) treated outside the Brazilian endemic area of malaria with only one course of quinine.We report the clinical picture, treatment and evolution of a child with hyperreactive malarious splenomegaly treated outside the endemic area of malaria. The patient presented gross splenomegaly, proceeded from an area where malaria is endemic, showed increased immunoglobulins levels, high antimalarial antibody titres and hepatic sinusoidal lymphocytosis. The child did not return to an area where malaria is endemic and showed a favorable response to only one course of quinine. The response of this patient to limited antimalarial therapy suggests the importance of reinfection with malaria in the development and maintenance of this syndrome.- - - - - - - - - - ranking = 4keywords = spleen (Clic here for more details about this article) |
7/12. plasmodium falciparum malaria in splenectomized patients: two case reports in french guiana and a literature review.Some of the immunologic mechanisms involved in malaria physiopathology remain unclear. In animals, the spleen seems to play a key role in protecting the host against malaria. However, little is known about the effect of spleen dysfunction on human malaria. We report two severe cases of plasmodium falciparum infection with unusual clinical and parasitologic features in two splenectomized men living in french guiana. The peripheral blood of these cases showed hyperparasitemia, with a high proportion of mature parasites and leukocytes with malaria pigment. Despite appropriate treatment and adequate absorption, hyperparasitemia persisted. Parasite clearance was delayed and one patient died. Only the patient who died had the merozoite surface protein 1 allele B-K1 and the varD gene genotype, which is considered to be a probable parasite virulence factor. These uncommon cases differ from most of those described in the literature, illustrating the complexity of the mechanisms underlying the protective function of the spleen in human malaria.- - - - - - - - - - ranking = 3keywords = spleen (Clic here for more details about this article) |
8/12. Acute plasmodium falciparum malaria following splenectomy for suspected lymphoma in 2 patients.Two black African immigrants, with no history of recent travel outside france, received a diagnosis of a malignant lymphoproliferative disorder and splenomegaly, and they subsequently underwent splenectomy. A few weeks after surgery, both patients experienced an acute episode of plasmodium falciparum malaria, so the initial diagnosis was corrected retrospectively and changed to hyperreactive malarial splenomegaly. These cases illustrate the difficulty in distinguishing hyperreactive malarial splenomegaly from malignant lymphoproliferative disorders and therefore underline the role of the spleen in the immune system's defense against malaria.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
9/12. Rupture of spleen in a mechanically ventilated patient with falciparum malaria admitted with pulmonary edema.Rupture of the spleen in malaria may constitute a diagnostic challenge to many clinicians particularly in non-endemic areas where experience with malaria is limited. Our aim is to increase the awareness among clinicians from non-endemic areas of serious malarial complications. We present a young American military man who was admitted to Hamad General Hospital and had 2 serious malarial complications, namely, acute pulmonary edema and rupture of the spleen. He was unusual compared with what was published previously in 4 main points: 1. The rupture of spleen occurred while the patient on mechanical ventilation and under the effect of sedation, which constituted a diagnostic challenge. 2. The 2 complications occurred in a patient with a low parasitemia. 3. The causative species for splenic rupture is plasmodium falciparum, and 4. The first sample of peripheral blood smear for malarial parasite was negative. We treated him successfully and discharged home in a good condition.- - - - - - - - - - ranking = 7keywords = spleen (Clic here for more details about this article) |
10/12. Development of hyperreactive malarious splenomegaly in an 8 year-old Caucasian boy, 18 months after residence in africa.Hyperreactive malarial splenomegaly (the former tropical splenomegaly syndrome) refers to a combination of splenomegaly, high antimalarial antibodies and high serum IgM content, a condition resulting from an aberrant immunological response to malaria. It has rarely been described in expatriates. We report the case of an 8 year-old Dutch boy who developed this syndrome 18 months after returning from Zaire. Treatment with mefloquine resulted in gradual improvement of all laboratory abnormalities. The spleen did not decrease in size, but became normal for age as height increased.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
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