Case Report: Severe Plasmodium vivax Malaria after Splenectomy

Abstract

Severe malaria after splenectomy has been reported with infections with Plasmodium falciparum, Plasmodium knowlesi, and Plasmodium malariae, but is less well-characterized with Plasmodium vivax. We describe a case of severe P. vivax malaria with hypotension, prostration, and acute kidney injury occurring 2 months after splenectomy in Papua, Indonesia. The patient was treated successfully with intravenous artesunate.

Figure 1.

(A) Microscopic images from a Giemsa-stained blood film during severe malaria episode are shown (i and ii), indicating the presence of Plasmodium vivax asexual stages (6% rings, 91% trophozoites, and 3% schizonts; black arrows) at a density of 12,246 parasites/μL. Absence of splenic function was confirmed by the presence of Howell-Jolly bodies on Giemsa-stained smears (iii; green arrowhead) and an elevated percentage of pocked red cells on wet mounts examined by differential interference contrast microscopy (iv; red arrows). (B) Longitudinal blood pressure and mean arterial pressure (MAP) measurements in the first 21 hours after initial clinical review. Vertical arrowheads indicate commencement of oral dihydroartemisinin–piperaquine antimalarials (oral DHP) prior to hospital admission (adm), and commencement of intravenous (IV) artesunate after admission. Horizontal arrow indicates duration of vasopressor treatment, which continued for 28 hours.