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Am. J. Trop. Med. Hyg., 81(5), 2009, pp. 758-762
doi:10.4269/ajtmh.2009.09-0348;
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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CASE REPORT


Histopathology of Fatal Respiratory Distress Caused by Plasmodium vivax Malaria

Neena Valecha*, Rock G. W. Pinto, Gareth D. H. Turner, Ashwani Kumar, Savio Rodrigues, Nagesh G. Dubhashi, Edmond Rodrigues, Sidhartha S. Banaulikar, Ruchi Singh, Aditya P. Dash, AND J. Kevin Baird*
National Institute of Malaria Research, Delhi, India; Departments of Pathology, Microbiology, Medicine and Forensic Medicine, Goa Medical College and Hospital, Bambolim, Goa, India; Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom; National Institute of Malaria Research Field Unit, Goa, India; Southeast Asian Infectious Diseases Clinical Research Network, Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom

 

ABSTRACT

An otherwise healthy 20-year-old woman in Goa, India, received antibiotics after a diagnosis of upper respiratory tract infection. One week later, vivax malaria was diagnosed at a health center, but the patient developed respiratory distress and lost consciousness. She arrived at emergency department in shock, breathless, and comatose. She died within minutes. Two independent laboratories later confirmed Plasmodium vivax by microscopy (140,000/µL) and by nested and real-time polymerase chain reaction methods. Post-mortem examination showed congestion of alveolar capillaries by heavy monocytic infiltrates, along with diffuse damage to alveolar membranes consistent with acute respiratory distress syndrome. Parasites seen in lung tissue were roughly proportionate to both peripheral hyperparasitemia and those seen in other organs without lesions. In this patient, vivax malaria caused a rapidly fatal respiratory distress.

Received June 22, 2009. Accepted for publication July 30, 2009.

Acknowledgments: The authors thank Professor Jeremy Farrar and Dr. Nicholas Anstey for helpful suggestions on this manuscript. The authors thank Awalludin Sutamihardja and Ika Susanti at the US Naval Medical Research Unit 2 in Jakarta, Indonesia, for the microscopic and molecular diagnostic analyses of samples from our patient. The American Society of Tropical Medicine and Hygiene (ASTMH) and the American Committee on Clinical Tropical Medicine and Travelers’ Health (ACCTMTH) assisted with publication expenses.

* Address correspondence to Neena Valecha, National Institute of Malaria Research, 22-Sham Nath Marg, Delhi 110 054, India, E-mail: neenavalecha{at}gmail.com; and Kevin Baird, Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No.69, Jakarta 10430, Indonesia, E-mail: kbaird{at}eocru.org.

Authors’ addresses: Neena Valecha, National Institute of Malaria Research, 22-Sham Nath Marg, Delhi 110054, India, E-mail: neenavalecha{at}gmail.com. Rock G. W. Pinto, Department of Pathology, Goa Medical College and Hospital, Bambolim-403202, Goa, India. Gareth D. H. Turner, Department of Cellular Pathology, Level 1, John Radcliffe Hospital, Oxford OX3 9DU, UK, E-mail: gareth.turner{at}orh.nhs.uk. Ashwani Kumar, National Institute of Malaria Research, Field Unit, Directorate of Health Services Building, Campal, Panaji-403001. Savio Rodrigues, Department of Microbiology, Goa Medical College and Hospital, Bambolim-403202, Goa, India. Nagesh G. Dubhashi, Department of Medicine, Goa Medical College and Hospital, Bambolim-403202, Goa, India. Edmond Rodrigues, Department of Forensic Medicine, Goa Medical College and Hospital, Bambolim-403202, Goa, India. Sidhartha S. Banaulikar, Department of Forensic Medicine, Goa Medical College and Hospital, Bambolim-403202, Goa, India. Ruchi Singh, National Institute of Malaria Research, 22 Sham Nath Marg, Delhi 110054, India. Aditya P. Dash, National Institute of Malaria Research, 22 Sham Nath Marg, Delhi 110054, India. Kevin Baird, Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No.69, Jakarta 10430, Indonesia, E-mail: kbaird{at}eocru.org.






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