Hemophagocytic syndrome associated with Plasmodium falciparum infection.

Hemophagocytic syndrome (HPS) has been associated with infections, hematological malignancies and autoimmune conditions. Malaria is rarely reported to cause HPS. We report a case of an 11-month-old infant with fever, hepatosplenomegaly, pancytopenia, high serum ferritin, hypertriglyceridemia, and bone marrow hemophagocytosis, consistent with hemophagocytic syndrome. Gametocytes of plasmodium falciparum were identified on bone marrow aspiration. Rapid recovery was observed after treatment with antimalarials.

The new and the old in malaria immunopathology

O termo "imunopatologia" pode ser considerado tanto como "uma patologia do sistema imune" quanto como "uma patologia provocada pelo sistema imune". Isso se aplica também no caso de infecções parasitárias como a malária na qual ambos os tipos de fenômeno säo comumente observados. Por quase meio século após a descoberta do Plasmodium, clínicos e patologistas deixaram-se seduzir pela fácil tentaçäo de explicar fenômenos como a anemia e a malária cerebral como complicações mecânicas da doença, resultantes da açäo direta de formas maduras do parasita, destruindo hemácias ou obliterando vasos capilares profundos. Nas últimas décas, entretanto, progressos substanciais no conhecimento da estrutura e funções das citocinas levaram a uma profunda revoluçäo na maneira de se ver a patologia da malária. Os conceiros atuais tendem a considerar que a maior parte da patogenia da malária resulta da interaçäo de distintos processos, e a dar mais ênfase ao efeito modulador de toxinas parasitárias na cascata de ativaçäo de citocinas do que aos óbvios componentes mecânicos da infecçäo parasitária. Neste artigo, revisamos criticamente alguns aspectos da patologia da malária que poderiam resultar de um sistema imune alterado. A anemia e a forma cerebral da malária Plasmodium falciparum assim como o envolvimento renal que acompanha a infecção por P. malariae. Também discutimos os mecanismos envolvidos nas perturbações do sistema imune. Ativação policlonal linfocitária, autoimunidade e imunodepressão.

Falciparum malaria-an experience with 100 cases

Clinical details and present day problems faced in 100 cases of Falciparum Malaria [FM] are reported. Eleven percent had taken chloroquine prior to reporting to us. The parasite density lacked correlation with the severity of disease. Pattern of fever varied markedly but 10% were afebrile throughout and presented only with body ache and malaise. Cerebral malaria was present in 11% patients. Jaundice was present in 18% patients. Other symptoms were vomiting 44%, severe headache 12%, pain abdomen 7%, loose motions/dysentery 11%, and cough 8%, while bleeding diathesis was present in 7% [3 melena, 2 epistaxis, 1 bleeding gums and 1 haematuria]. Severe anaemia was present in 10% of cases. Splenomegaly was present in 65%, hepatomegaly 29% and hepatosplenomegaly 21%. Congenital malaria was present in only one [1%] patient. Mild malaria patients were treated with chloroquine, while severe malaria patients were cured with quinine for 7 days. Blackwater fever was present in 2%. Patients with blackwater fever were cured with steroids and chloroquine. 12% patients had chronic malaria. 83% of these patients presented with anaemia. Self medication, haphazard therapy and the slogan "Fever May Be Malaria, Take Chloroquine" can lead to problems in Falciparum Malaria. Clinical immunity and parasite strain may act as virulence factors