Volume 71, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 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 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.


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  1. Wyler DJ, Oster CN, Quinn TC, 1983. The Role of the Spleen in Malaria Infections. The Role of the Spleen in the Immunology of Parasitic Diseases. Tropical Disease Research Series No. 1. Basel, Switzerland: Schwabe and Co., 183–204.
  2. Adams ARD, 1961. Laboratory meeting. Trans R Soc Trop Med Hyg 55 : 7.
  3. Garnham PCC, 1970. The role of the spleen in protozoal infections with special reference to splenectomy. Acta Trop 27 : 1–14.
  4. Walzer PD, Gibson JJ, Schultz MG, 1974. Malaria fatalities in United States. Am J Trop Med Hyg 23 : 328–333.
  5. Tapper ML, Armstrong D, 1976. Malaria complicating neoplasic disease. Arch Intern Med 136 : 807–810.
  6. Tsuchida H, Yamaguchi K, Yamamoto S, Ebisawa I, 1982. Quartan malaria following splenectomy 36 years after infection. Am J Trop Med Hyg 31 : 163–165.
  7. Maharaj D, Mc Donald GA, Dobbie JW, 1982. Splenectomy and blackwater fever. Br J Haematol 51 : 663–664.
  8. Israeli A, Shapiro M, Ephros MA, 1987. Plasmodium falciparum malaria in an asplenic man. Trans R Soc Trop Med Hyg 81 : 233–234.
  9. Petersen E, Hogh B, Marbiah NT, Hanson AP, 1992. The effect of splenectomy on immunity to Plasmodium malariae and Plasmodium falciparum in a malaria immune donor. Trop Med Parasitol 43 : 68–69.
  10. Looareesuwan S, Suntharasamai P, Webster HK, Ho M, 1993. Malaria in splenectomized patients: report of four cases and review. Clin Infect Dis 16 : 361–366.
  11. Guerin B, Bouchaud O, Gachot B, Lebras J, Saimot AG, 1996. Persistance d’une parasitémie après traitement d’un accès palustre à Plasmodium falciparum chez un patient splénctomisé non-immun. Ann Med Interne (Paris) 147 : 129–130.
  12. Thu TA, Davis TME, Binh TQ, Van Phuong N, Anh TK, 1997. Delayed parasite clearance in a splenectomized patient with Plasmodium malaria who was treated with artemisin derivatives. Clin Infect Dis 25 : 925–926.
  13. Singh N, Nagpal AC, Gupta RB, 2002. Failure of chloroquine therapy in splenectomized child infected with Plasmodium vivax. Ann Trop Med Parasitol 96 : 109–111.
  14. Institut National de la Statistique et des Etudes Epidémiologique (INSEE), 1999. Recensement de la Population Française, 973 Guyane. Paris: INSEE.
  15. Carme B, Venturin C, 1999. Le paludisme dans les Amériques. Tendances 1970–1998. Med Trop (Mars) 59 : 298–302.
  16. Strobel M, Lefait JF, Dedet JP, 1985. Paludisme à Plasmodium falciparum chez les amérindiens Wayanas de Guyane française. Etude séro-épidémiologique d’une population immune. Med Mal Infect 4 : 162–164.
  17. Silamut K, White NJ, 1993. Relation of the stage of parasite development in the peripheral blood to prognosis in severe falciparum malaria. Trans R Soc Trop Med Hyg 87 : 436–443.
  18. Chotivanich K, Udomsangpetch R, McGready R, Proux S, Newton P, Pukrittayakamee S, Looareesuwan S, White NJ, 2002. Central role of the spleen in malaria parasite clearance. J Infect Dis 185 : 1538–1541.
  19. Ariey F, Hommel D, LeScanf C, Duchemin JB, Peneau C, Hulin A, Sarthou JL, Reynes JM, Fandeur T, Mercereau-Puijalon O, 2001. Association of severe malaria with a specific. Plasmodium falciparum genotype in French Guiana. J Infect Dis 184 : 237–241.
  20. David PH, Hommel M, Miller LH, Udeinya IJ, Oligino LD, 1983. Parasite sequestration in Plasmodium falciparum malaria: spleen and antibody modulation of cytoadeherence of infected erythrocytes. Proc Natl Acad Sci USA 80 : 5075–5079.
  21. Ho M, White NJ, Looareesuwan S, 1990. Splenic Fc receptor function in host defense and anemia in acute Plasmodium falciparum malaria. J Infect Dis 161 : 555–561.
  22. World Health Organization, 2000. Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. Trans R Soc Trop Med Hyg 94 (Suppl 1): S1–S90.
  23. World Health Organization, 1973. Chemotherapy of malaria and resistance to antimalarials: report of a WHO scientific group. World Health Organ Tech Rep Ser 529 : 30–35.
  24. Demar M, Carme B, 2004. Plasmodium falciparum in vivo resistance to quinine: description of two RIII responses in French Guiana. Am J Trop Med Hyg 70 : 125–127.

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  • Received : 04 Nov 2003
  • Accepted : 05 Apr 2004

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