Acute kidney injury associated with Plasmodium malariae infection

Abstract

According to current estimates, Plasmodium malariae is not very common in Senegal, as more than 98% of malaria cases are suspected to be due to Plasmodium falciparum. However, it is possible that other malarial species are being under-reported or misdiagnosed. This is a report of a case of P. malariae in a 30-year-old man previously hospitalized with acute kidney injury after treatment with quinine and re-hospitalized three months later. He was diagnosed with renal cortical necrosis post malaria treatment. Plasmodium malariae was identified with light microscope and confirmed using species-specific small-subunit rRNA (ssrRNA) amplification.The patient was treated for malaria with intravenous quinine for seven days, followed by three days of oral treatment; the bacterial infection was treated using ceftriaxone during the first hospitalization and ciprofloxacin associated with ceftriaxone the second time. He also had four rounds of dialysis after which he partially recovered the renal function. Given the complications that can be caused by P. malariae infection, it should be systematically looked for, even if the predominant species is P. falciparum in Senegal.

Figure 1

Giemsa-stained thin smear of patient’s peripheral blood. A: Schizont of P. malariae containing merozoites (6 to 12) with large nuclei and the rosette pattern. B and C: Trophozoites of P. malariae “Basket-form” in a thin smear.

Figure 2

PCR results for Plasmodium species-specific 18S rRNA. 144-bp fragment corresponds to P. malariae was detected from the PCR-amplified product of thev patient’s blood 205 bp fragment corresponds to P. falciparum used as a positive control 117 pb fragment corresponds to P. vivax used as positive control. Ladder: DNA size marker (100 pb).