• 1.

    Kim EM, Cho HJ, Cho CR, Kwak YG, Kim MY, Cho YK, 2010. Abdominal computed tomography findings of malaria infection with Plasmodium vivax. Am J Trop Med Hyg 83: 12021205.

    • Search Google Scholar
    • Export Citation
  • 2.

    Imbert P, Rapp C, Buffet P, 2009. Pathological rupture of the spleen in malaria: analysis of 55 cases (1958–2008). Travel Med Infect Dis 7: 147159.

    • Search Google Scholar
    • Export Citation
  • 3.

    McKenzie FE, Jeffery GM, Collins WE, 2002. Plasmodium vivax blood-stage dynamics. J Parasitol 88: 521535.

  • 4.

    Urban BC, Hien TT, Day NP, Phu NH, Roberts R, Pongponratn E, Jones M, Mai NT, Bethell D, Turner GD, Ferguson D, White NJ, Roberts D, 2005. Fatal Plasmodium falciparum malaria causes specific patterns of splenic architectural disorganization. Infect Immun 73: 19861994.

    • Search Google Scholar
    • Export Citation
  • 5.

    Buffet PA, Safeukui I, Deplaine G, Brousse V, Prendki V, Thellier M, Turner G, Mercereau-Puijalon O, 2011. The pathogenesis of Plasmodium falciparum malaria in humans: insights from spleen physiology. Blood 117: 381392.

    • Search Google Scholar
    • Export Citation
  • 6.

    Deplaine G, Safeukui I, Jeddi F, Lacoste F, Brousse V, Perrot S, Biligui S, Guillotte M, Guitton C, Dokmak S, Aussilhou B, Sauvanet A, Couvelard A, Paye F, Thellier M, Mazier D, Milon G, Mohandas N, Mercereau-Puijalon O, David PH, Buffet PA, 2011. The sensing of poorly deformable red blood cells by the human spleen can be mimicked in vitro. Blood 117: e8895.

    • Search Google Scholar
    • Export Citation
  • 7.

    Anstey NM, Russell B, Yeo TW, Price RN, 2009. The pathophysiology of vivax malaria. Trends Parasitol 25: 220227.

  • 8.

    Imbert P, Rapp C, Ficko C, Buffet P, 2010. Left upper quadrant abdominal pain in malaria: suspect pathological splenic rupture first. Trans R Trop Med Hyg 104: 628629.

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    • Export Citation
 
 

 

 

 

 

 

 

Abdominal Computed Tomography Scan: A Useful Diagnosis Tool for Early and Delayed Splenic Complications in Malaria

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  • 1 Service des Maladies Iinfectieuses et Tropicales
  • | 2 Hôpital d'Instruction des Armées Bégin
  • | 3 Saint-Mandé Cedex, France
  • | 4 E-mail: patrick.imbert@santarm.fr
  • | 5 Service des Maladies Infectieuses et Tropicales
  • | 6 Hôpital d'Instruction des Armées Bégin
  • | 7 Saint-Mandé Cedex, France
  • | 8 Service de Parasitologie Mycologie (Pr. Mazier), & UMR945, INSERM
  • | 9 Paris 6 University
  • | 10 Groupe Hospitalier Pitié-Salpêtrière
  • | 11 Paris Cedex, France
  • | 12 Service des Maladies Infectieuses et Tropicales
  • | 13 Hôpital d'Instruction des Armées Bégin
  • | 14 Saint-Mandé Cedex, France

Dear Sir:

We read with great interest the study on the abdominal computed tomography (CT) scan during acute vivax malaria in South Korea by Kim and others.1

In our recent analysis of 55 cases of pathological rupture on the spleen in malaria,2 we found that 23 (42%) were caused by Plasmodium vivax. We therefore agree with Kim and others that infection with P. vivax—less prevalent worldwide than Plasmodium falciparum—likely carry a higher risk of splenic complications than infection with P. falciparum. Acute splenic enlargement, which is as frequent in P. vivax as in P. falciparum infection despite lower mean parasitemia in the former,3 is likely to be a major determinant of both splenic infarction and splenic rupture in malaria. Splenic enlargement during lethal falciparum malaria likely results from splenic congestion with surface-altered and mechanically altered red blood cells (either infected or uninfected), and with migration or local multiplication of white blood cells.46 Because patients with vivax malaria rarely die, post-mortem data on the spleen in this context are very limited.7

The mechanistic connections between malaria, splenic infarction, and pathological splenic rupture are not clearly established. Although splenic infarction leads to splenic rupture in a small number of patients, 53 of the 55 malaria patients with pathological splenic rupture had no obvious signs of pre-existing infarction.8

Not least, pathological rupture of the spleen and other splenic complications may occur well beyond the acute phase of the malaria attack (median time from fever onset to rupture: 5 d, range: 0–37; median time from malaria diagnosis to rupture: 0 d, range: 0–31).2 Because Kim and others excluded patients in whom the CT scan had been performed more than 3 days after the diagnosis of malaria, a proportion of splenic complications was likely to be ignored in their study.1 Clinicians should be aware of the (small but life-threatening) risk of a delayed splenic rupture after a malaria attack.

  • 1.

    Kim EM, Cho HJ, Cho CR, Kwak YG, Kim MY, Cho YK, 2010. Abdominal computed tomography findings of malaria infection with Plasmodium vivax. Am J Trop Med Hyg 83: 12021205.

    • Search Google Scholar
    • Export Citation
  • 2.

    Imbert P, Rapp C, Buffet P, 2009. Pathological rupture of the spleen in malaria: analysis of 55 cases (1958–2008). Travel Med Infect Dis 7: 147159.

    • Search Google Scholar
    • Export Citation
  • 3.

    McKenzie FE, Jeffery GM, Collins WE, 2002. Plasmodium vivax blood-stage dynamics. J Parasitol 88: 521535.

  • 4.

    Urban BC, Hien TT, Day NP, Phu NH, Roberts R, Pongponratn E, Jones M, Mai NT, Bethell D, Turner GD, Ferguson D, White NJ, Roberts D, 2005. Fatal Plasmodium falciparum malaria causes specific patterns of splenic architectural disorganization. Infect Immun 73: 19861994.

    • Search Google Scholar
    • Export Citation
  • 5.

    Buffet PA, Safeukui I, Deplaine G, Brousse V, Prendki V, Thellier M, Turner G, Mercereau-Puijalon O, 2011. The pathogenesis of Plasmodium falciparum malaria in humans: insights from spleen physiology. Blood 117: 381392.

    • Search Google Scholar
    • Export Citation
  • 6.

    Deplaine G, Safeukui I, Jeddi F, Lacoste F, Brousse V, Perrot S, Biligui S, Guillotte M, Guitton C, Dokmak S, Aussilhou B, Sauvanet A, Couvelard A, Paye F, Thellier M, Mazier D, Milon G, Mohandas N, Mercereau-Puijalon O, David PH, Buffet PA, 2011. The sensing of poorly deformable red blood cells by the human spleen can be mimicked in vitro. Blood 117: e8895.

    • Search Google Scholar
    • Export Citation
  • 7.

    Anstey NM, Russell B, Yeo TW, Price RN, 2009. The pathophysiology of vivax malaria. Trends Parasitol 25: 220227.

  • 8.

    Imbert P, Rapp C, Ficko C, Buffet P, 2010. Left upper quadrant abdominal pain in malaria: suspect pathological splenic rupture first. Trans R Trop Med Hyg 104: 628629.

    • Search Google Scholar
    • Export Citation
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