• 1.

    Mueller I, Zimmerman PA, Reeder JC, 2007. Plasmodium malariae and Plasmodium ovale—the ‘bashful’ malaria parasites. Trends Parasitol 23: 278283.

    • Search Google Scholar
    • Export Citation
  • 2.

    Yerlikaya S, Campillo A, Gonzalez IJ, 2018. A systematic review: performance of rapid diagnostic tests for the detection of Plasmodium knowlesi, Plasmodium malariae, and Plasmodium ovale monoinfections in human blood. J Infect Dis 218: 265276.

    • Search Google Scholar
    • Export Citation
  • 3.

    Vinetz JM, Li J, Mccutchan TF, Kaslow DC, 1998. Plasmodium malariae infection in an asymptomatic 74-year-old Greek woman with splenomegaly. New Engl J Med 338: 367371.

    • Search Google Scholar
    • Export Citation
  • 4.

    Phuong M, Lau R, Ralevski F, Boggild AK, 2014. Sequence-based optimization of a quantitative real-time PCR assay for detection of Plasmodium ovale and Plasmodium malariae. J Clin Microbiol 52: 10681073.

    • Search Google Scholar
    • Export Citation
  • 5.

    Yavne Y, Leshem E, Paran Y, Nadir E, Weinberger M, Stein M, Petersiel N, Yahav D, Grossman T, Schwartz E, 2017. Plasmodium malariae in Israeli travelers: a nationwide study. Clin Infect Dis 65: 15161522.

    • Search Google Scholar
    • Export Citation
  • 6.

    Maguire JD, Sumawinata IW, Masbar S, Laksana B, Prodjodipuro P, Susanti I, Sismadi P, Mahmud N, Bangs MJ, Baird JK, 2002. Chloroquine-resistant Plasmodium malariae in south Sumatra, Indonesia. Lancet 360: 5860.

    • Search Google Scholar
    • Export Citation
  • 7.

    Hedelius R, Fletcher JJ, Glass WF, Susanti AI, Maguire JD, 2011. Nephrotic syndrome and unrecognized Plasmodium malariae infection in a US navy sailor 14 years after departing Nigeria. J Travel Med 18: 288291.

    • Search Google Scholar
    • Export Citation
 
 
 

 

 
 
 

 

 

 

 

 

 

Plasmodium malariae—Repeat Light Microscopy when Molecular Testing is Not Available

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  • 1 Department of Internal Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia;
  • | 2 Department of Infectious Disease, Naval Medical Center Portsmouth, Portsmouth, Virginia

A 31-year-old previously healthy male required hospital admission after returning from rural Cameroon 10 weeks prior with severe myalgia, chills, 72 hours cyclical fever to 103.1°F, and tachycardia for 2 weeks. He endorsed adherence to atovoquone/proguanil chemoprophylaxis and recalled no exposure to lake or stream water. He was ill appearing, but without focal abnormalities. Laboratory findings were significant for leukopenia 2,900 cells/uL, thrombocytopenia 82,000 cells/uL, aspartate aminotranferase 316 units/L, and alanine aminotransferase 400 units/L. Initial three light microscopy (LM) and rapid diagnostic test (RDT) with BinaxNOW (Alere, Inc., Waltham, MA) were negative. However, continued investigation eventually revealed Plasmodium malariae on the fourth LM in its pathognomonic “rosette” schizont (Figure 1) and “band”–developing gametocyte (Figure 2).1 The patient was treated effectively with artemether/lumefantrine. Plasmodium malariae infections were once considered a rare and mild illness largely because of poor sensitivity on RDT and LM.13 However, recent improvement in polymerase chain reaction (PCR) technique increased the identification of P. malariae that might have been misdiagnosed as fever of unknown origin.35 Although there were reports of late onset and recrudescent fever despite adherent chemoprophylaxis, subsequent treatment has been paradoxically successful with the same medication.3,5,6 Because of P. malariae’s long senescent periods, recrudescent ability, and low parasite burden, clinicians must have high clinical suspicion and consider repeating LM when resource is limited or using PCR for diagnosis.7

Figure 1.
Figure 1.

“Rosette” schizont.

Citation: The American Journal of Tropical Medicine and Hygiene 100, 2; 10.4269/ajtmh.18-0592

Figure 2.
Figure 2.

“Band”–developing gametocyte.

Citation: The American Journal of Tropical Medicine and Hygiene 100, 2; 10.4269/ajtmh.18-0592

REFERENCES

  • 1.

    Mueller I, Zimmerman PA, Reeder JC, 2007. Plasmodium malariae and Plasmodium ovale—the ‘bashful’ malaria parasites. Trends Parasitol 23: 278283.

    • Search Google Scholar
    • Export Citation
  • 2.

    Yerlikaya S, Campillo A, Gonzalez IJ, 2018. A systematic review: performance of rapid diagnostic tests for the detection of Plasmodium knowlesi, Plasmodium malariae, and Plasmodium ovale monoinfections in human blood. J Infect Dis 218: 265276.

    • Search Google Scholar
    • Export Citation
  • 3.

    Vinetz JM, Li J, Mccutchan TF, Kaslow DC, 1998. Plasmodium malariae infection in an asymptomatic 74-year-old Greek woman with splenomegaly. New Engl J Med 338: 367371.

    • Search Google Scholar
    • Export Citation
  • 4.

    Phuong M, Lau R, Ralevski F, Boggild AK, 2014. Sequence-based optimization of a quantitative real-time PCR assay for detection of Plasmodium ovale and Plasmodium malariae. J Clin Microbiol 52: 10681073.

    • Search Google Scholar
    • Export Citation
  • 5.

    Yavne Y, Leshem E, Paran Y, Nadir E, Weinberger M, Stein M, Petersiel N, Yahav D, Grossman T, Schwartz E, 2017. Plasmodium malariae in Israeli travelers: a nationwide study. Clin Infect Dis 65: 15161522.

    • Search Google Scholar
    • Export Citation
  • 6.

    Maguire JD, Sumawinata IW, Masbar S, Laksana B, Prodjodipuro P, Susanti I, Sismadi P, Mahmud N, Bangs MJ, Baird JK, 2002. Chloroquine-resistant Plasmodium malariae in south Sumatra, Indonesia. Lancet 360: 5860.

    • Search Google Scholar
    • Export Citation
  • 7.

    Hedelius R, Fletcher JJ, Glass WF, Susanti AI, Maguire JD, 2011. Nephrotic syndrome and unrecognized Plasmodium malariae infection in a US navy sailor 14 years after departing Nigeria. J Travel Med 18: 288291.

    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Serena Zhang, LT, US Navy, Department of Internal Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708. E-mail: s.zhang9876@gmail.com

Copyright statement: We are military service members. This work was prepared as part of our official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

Authors’ addresses: Serena X. Zhang, Department of Internal Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, E-mail: s.zhang9876@gmail.com. Karl C. Kronmann and Michael J. Kavanaugh, Department of Infectious Disease, Naval Medical Center Portsmouth, Portsmouth, VA, E-mails: karl.c.kronmann.mil@mail.mil and michael.j.kavanaugh.mil@mail.mil.

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