Keywords
Plasmodium falciparum
sequelae
artesunate
autoimmune haemolytic anaemia
How to Cite
Abstract
Malaria is a severe parasitic disease caused by a protozoan of the Plasmodium genus, widespread in the worm climate tropical areas. High temperatures and humidity favor the multiplication of the malaria vector – the Anopheles mosquito, whose female is responsible for the transmission of the infection in the natural environment.
The study presents a complicated case of malaria caused by P. falciparum with a high parasitemia of 11% and symptoms of multi-organ injuries – acute renal failure with black water fever and anuria, impaired consciousness related to ischaemia of the brain with cerebral malaria, hemorrhagic diathesis, respiratory distress, liver damage, hyperpyrexia, hypotension, which developed as a result of delayed diagnosis and transport of the patient to a tropical centre. The patient stayed in Guinea for 2 weeks for business purposes, without using pharmacological prophylaxis against malaria recommended for this geographical zone of the world. A similarly severe clinical picture of malaria was observed in a colleague from Belgium, who was treated at the same time in his country. The therapy included intravenous artesunate and symptomatic treatment, achieving complete eradication of parasitaemia from peripheral blood already on the 3rd day of antimalarial pharmacotherapy. In the 3rd week of hospitalization during the convalescence period, there were signs of rapidly deepening anaemia not related to recurrence of infection, ineffective therapy, or resistance to the antimalarial drugs used. Immunodiagnostic tests detecting the presence of immunoglobulin IgG coating the patient’s erythrocytes confirmed acute haemolytic anaemia of autoimmune aetiology following artesunate therapy. In the treatment of the rare complication, blood transfusions and systemic steroids were used with a positive therapeutic effect.
Treatment of complicated cases of malaria requiring parenteral artemisinin preparations should be carried out in reference centres with documented practical experience in this field.
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