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. 2013 Apr 10:14:103-5.
doi: 10.12659/AJCR.883879. Print 2013.

Co-incidental Plasmodium Knowlesi and Mucormycosis infections presenting with acute kidney injury and lower gastrointestinal bleeding

Arunachalam Ramaswami  1 , Jayakrishnan K Pisharam, Hla Aung, Kafeel Ghazala, Khalil Maboud, Vui Heng Chong, Jackson Tan
Affiliations

Co-incidental Plasmodium Knowlesi and Mucormycosis infections presenting with acute kidney injury and lower gastrointestinal bleeding

Arunachalam Ramaswami et al. Am J Case Rep. .

Abstract

Background: Plasmodium knowlesi is frequently reported in Southeast Asian countries and is now widely regarded as the fifth malarial parasite. Mucormycosis is a rare fungal infection that can occur in patients with a weakened immune system.

Case report: We report a case of acute kidney injury secondary to Plasmodium knowlesi malaria infection and mucormycosis fungal infection. In addition, the patient also had lower gastrointestinal bleeding from invasive gastrointestinal mucormycosis. P. knowlesi infection was diagnosed by blood film and mucormycosis was diagnosed by histopathological examination of biopsy specimen of the colon. The patient recovered with antimalarial treatment (Quinine), antifungal treatment (Lipophilic Amphotericin), and supportive hemodialysis treatment.

Conclusions: We hypothesize that P. knowlesi malarial infection can lower the immunologic threshold and predisposes vulnerable individuals to rare disseminated fungal infections. To the best of our knowledge, this is the first P. Knowlesi malaria-associated invasive fungal infection reported in the literature.

Keywords: Plasmodium knowlesi; acute kidney injury; gastro-intestinal bleeding; malaria; mucormycosis.

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Figures

Figure 1
Figure 1
Peripheral blood film.
Figure 2
Figure 2
Colonic Biopsy: Broad aseptate fungal hyphae in lamina propria. Inset shows black fungal hyphae stained by Gomori Methemamine Silver Stain (GMS Stain).
See this image and copyright information in PMC

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