An imported case of severe falciparum malaria with prolonged hemolytic anemia clinically mimicking a coinfection with babesiosis.

Content Provider	Europe PMC
Author	Na, Young Ju Chai, Jong-Yil Jung, Bong-Kwang Lee, Hyun Jung Song, Ji Young Je, Ji Hye Seo, Ji Hye Park, Sung Hun Choi, Ji Seon Kim, Min Ja
Copyright Year	2014
Abstract	While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.
ISSN	00234001
Journal	The Korean Journal of Parasitology
Volume Number	52
PubMed Central reference number	PMC4277030
Issue Number	6
PubMed reference number	25548419
e-ISSN	17380006
DOI	10.3347/kjp.2014.52.6.667
Language	English
Publisher	The Korean Society for Parasitology and Tropical Medicine
Publisher Date	2014-12-23
Access Restriction	Open
Rights License	This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2014, Korean Society for Parasitology and Tropical Medicine
Subject Keyword	Plasmodium falciparum imported malaria falciparum malaria babesiosis hemolytic anemia artesunate
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Parasitology