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Am. J. Trop. Med. Hyg., 71(3), 2004, pp. 290-293
Copyright © 2004 by The American Society of Tropical Medicine and Hygiene

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PLASMODIUM FALCIPARUM MALARIA IN SPLENECTOMIZED PATIENTS: TWO CASE REPORTS IN FRENCH GUIANA AND A LITERATURE REVIEW

MAGALIE DEMAR, ERIC LEGRAND, DIDIER HOMMEL, PHILIPPE ESTERRE, AND BERNARD CARME
Parasitology-Mycology Laboratory, French West Indies and Guiana Faculty of Medicine and Cayenne Central Hospital (EA3593 Team), Cayenne, French Guiana; National Reference Center on Plasmodium Chemoresistance in the French West Indies and French Guiana, Institut Pasteur de Guyane, Cayenne, French Guiana; Intensive Care Unit, Cayenne Central Hospital, Cayenne, French Guiana

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.

Received November 4, 2003. Accepted for publication April 5, 2004.

Acknowledgments: We thank Anne Lavergne for aligning the msp-1 gene and Ruth Mathar-Heraud for evaluating parasitemia and parasite distribution and counting the leukocytes with malaria pigment.

Financial support: This work was supported by the Délégation Générale du Réseau des Instituts Pasteur and Instituts Associées.

Authors’ addresses: Magalie Demar and Bernard Carme, Parasitology-Mycology Laboratory, French West Indies and Guiana Faculty of Medicine and Cayenne Central Hospital (EA3593 Team), BP 6006, 97306 Cayenne, French Guiana, Telephone/Fax: 594-594-39-53-09 or 594-594-28-72-63, E-mails: mdemar{at}yahoo.com and b.carme{at}nplus.gf. Eric Legrand and Philippe Esterre, National Reference Center on Plasmodium Chemoresistance in the French West Indies and French Guiana, Institut Pasteur de Guyane, Cayenne, French Guiana, E-mails: elegrand{at}pasteur-cayenne.fr and pesterre{at}pasteur-cayenne.fr. Didier Hommel, Intensive Care Unit, Cayenne Central Hospital, Cayenne, French Guiana, E-mail: dhommel{at}compuserve.com.




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Copyright © 2004 by the American Society of Tropical Medicine and Hygiene.