Mixed Infection with Plasmodium falciparum and Plasmodium ovale in a Returned Traveller: the First Case in Korea

Mixed-species malaria infections are often unrecognized or underestimated. We hereby report the first described case of mixed infection with Plasmodium falciparum and Plasmodium ovale malaria in a returned traveller in Korea. In August 2016, a 25-year-old returned traveller from Cameroon and Democratic Republic of Congo presented with fever. He was diagnosed as P. falciparum malaria and successfully treated with artesunate. And 5 weeks after the completion of treatment, he presented with fever and diagnosed as P. ovale infection. P. ovale infection is a rare cause of malaria and often shows delayed presentation due to its dormant liver stage as hypnozoites. At re-presentation, the immunochromatographic test and microscopic examinations of our patient did not reveal P. ovale, which was only detected via polymerase chain reaction (PCR) assay. This case highlights the importance of considering malaria infection even in persons who have previously received malaria treatment. It also shows the usefulness of PCR testing for diagnosing P. ovale infections, which often present with a low level of parasitaemia.

A Case of Methemoglobinemia Caused by Primaquine / 대한내과학회지

Primaquine is often administered for the hypnozoite stage of Plasmodium vivax and Plasmodium ovale. Primaquine (with clindamycin) is also an alternative drug for treatment of pneumocystis pneumonia when trimethoprim/sulfamethoxazole cannot be used. Primaquine may cause methemoglobinemia, an altered state of hemoglobin in which the ferrous state of heme is oxidized to the ferric state. We report a case of methemoglobinemia caused by a standard dose of primaquine plus clindamycin in a 27-year-old female recipient of a kidney transplant who was diagnosed with pneumocystis pneumonia.

Characteristics of Imported Malaria and Species of Plasmodium Involved in Shandong Province, China (2012-2014)

Malaria remains a serious public health problem in Shandong Province, China; therefore, it is important to explore the characteristics of the current malaria prevalence situation in the province. In this study, data of malaria cases reported in Shandong during 2012-2014 were analyzed, and Plasmodium species were confirmed by smear microscopy and nested-PCR. A total of 374 malaria cases were reported, 80.8% of which were reported from 6 prefectures. Of all cases, P. falciparum was dominant (81.3%), followed by P. vivax (11.8%); P. ovale and P. malariae together accounted for 6.4% of cases. Notably, for the first time since 2012, no indigenous case had been reported in Shandong Province, a situation that continued through 2014. Total 95.2% of cases were imported from Africa. The ratio of male/female was 92.5:1, and 96.8% of cases occurred in people 20-54 years of age. Farmers or laborers represented 77.5% of cases. No significant trends of monthly pattern were found in the reported cases. All patients were in good condition after treatment, except for 3 who died. These results indicate that imported malaria has increased significantly since 2012 in Shandong Province, especially for P. falciparum, and there is an emergence of species diversity.

Primer reporte de un caso importado de Malaria por plasmodium ovale curtisi en Paraguay, confirmado por diagnóstico molecular / First report of an imported case of plasmodium ovale curtisi malaria in Paraguay confirmed by molecular diagnosis

En países donde el Plasmodium ovale no es común, los microscopistas tienden a identificarlo de manera errónea como Plasmodium vivax. En este trabajo reportamos la identificación de la especie P. ovale curtisi por el método de PCR múltiple semianidada (SnM-PCR) y la secuenciación de la subunidad pequeña del gen del ARN 18S, en un paciente paraguayo de 44 años de edad que vino en el 2.013 de Guinea Ecuatorial, África Occidental, a quien se le diagnosticó una infección por P. vivax por microscopía convencional. El empleo de métodos moleculares para la identificación de casos importados de infección con especies del género Plasmodium es uno de los objetivos principales en el control y la prevención de la malaria en Paraguay, teniendo en cuenta que el país se encuentra en fase de pre-eliminación de la enfermedad.

In countries where Plasmodium ovale is not common, the microscopists often mistakenlyidentify it as Plasmodium vivax. Here, we report the identification of the specie P. ovalecurtisi by the Seminested Multiplex PCR (SnM-PCR) technique and sequencing of the 18ssuRNA gene in a 44-year old Paraguayan male who came in 2013 from the EquatorialGuinea, Western Africa, and was diagnosed as having P. vivax infection by conventionalmicroscopy. Molecular biology tools for the identification of imported cases of infectionwith species of the genus Plasmodium is one of the main goals in the control andprevention of malaria in Paraguay, considering that the country is in the pre-eliminationphase of the disease.

A Case of Plasmodium ovale Malaria Imported from West Africa

Malaria is a parasitic infection caused by Plasmodium species. Most of the imported malaria in Korea are due to Plasmodium vivax and Plasmodium falciparum, and Plasmodium ovale infections are very rare. Here, we report a case of a 24-year-old American woman who acquired P. ovale while staying in Ghana, West Africa for 5 months in 2010. The patient was diagnosed with P. ovale malaria based on a Wright-Giemsa stained peripheral blood smear, Plasmodium genus-specific real-time PCR, Plasmodium species-specific nested PCR, and sequencing targeting 18S rRNA gene. The strain identified had a very long incubation period of 19-24 months. Blood donors who have malaria with a very long incubation period could be a potential danger for propagating malaria. Therefore, we should identify imported P. ovale infections not only by morphological findings but also by molecular methods for preventing propagation and appropriate treatment.

A Case of Plasmodium ovale wallikeri Infection in a Chinese Worker Returning from West Africa

In contrast to the gradual reduction in the number of locally transmitted malaria cases in China, the number of imported malaria cases has been increasing since 2008. Here, we report a case of a 39-year-old Chinese man who acquired Plasmodium ovale wallikeri infection while staying in Ghana, West Africa for 6 months in 2012. Microscopic examinations of Giemsa-stained thin and thick blood smears indicated Plasmodium vivax infection. However, the results of rapid diagnostic tests, which were conducted 3 times, were not in agreement with P. vivax. To further check the diagnosis, standard PCR analysis of the small-subunit rRNA gene was conducted, based on which a phylogeny tree was constructed. The results of gene sequencing indicated that this malaria is a variant of P. ovale (P. ovale wallikeri). The infection in this patient was not a new infection, but a relapse of the infection from the one that he had contracted in West Africa.

A Case of Plasmodium ovale Malaria Imported from West Africa

In Korea, the majority of imported malaria cases are Plasmodium vivax and P. falciparum, but Plasmodium ovale cases are rarely reported. We describe an imported case of P. ovale that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 37-yr-old male had visited the Republic of Ghana in tropical West Africa 3 months ago, and suffered from fever and headache since 2 weeks after his return to Korea. The results of rapid malaria test using SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Plasmodium species was observed in Wright-Giemsa-stained peripheral blood smear. For the evaluation of possible mixed infection and identification of species, we performed a nested PCR targeting the SSU rRNA gene. P. ovale single infection was confirmed by PCR. The sequence analysis of the P. ovale SSU rRNA gene showed that our isolate was P. ovale classic type. We should confirm P. ovale infection for an accurate diagnosis and treatment of imported malaria cases in Korea because the number of travelers to P. ovale-endemic regions has recently increased.

A History of Malaria in Modern Korea 1876-1945 / 의사학

Although it is not certain when malaria began to appear in Korea, malaria is believed to have been an endemic disease from ancient times. It was Dr. H. N. Allen (1858-1932) who made the first description and diagnosis of malaria in terms of Western medicine. In his first year report (1885) of Korean Government Hospital he mentioned malaria as the most prevalent disease. Very effective anti-malarial drug quinine was imported and it made great contribution in treating malaria. After Japan had annexed Korea in 1910, policies for public health system were fundamentally revised. Japan assumed control of Korean medical institutions and built high-quality Western hospitals for the health care of Japanese residents. The infectious diseases which were under special surveillance were cholera, typhoid fever, dysentery, typhus, scarlet fever, smallpox, and paratyphoid fever. Among chronic infectious diseases tuberculosis and leprosy were those under special control. Malaria, however, was not one of these specially controlled infectious diseases although it was widely spread throughout the peninsula. But serious studies on malaria were carried out by Japanese medical scientists. In particular, a Japanese parasitologist Kobayasi Harujiro(1884-1969) carried out extensive studies on human parasites, including malaria, in Korea. According to his study, most of the malaria in Korea turned out to be tertian fever. In spite of its high prevalence, malaria did not draw much attention from the colonial authorities and no serious measure was taken since tertian fever is a mild form of malaria caused by Plasmodium vivax and is not so much fatal as tropical malaria caused by P. falciparum. And tertian malaria was easily controlled by taking quinine. Although the majority of malaria in Korea was tertian fever, other types were not absent. Quartan fever was not rarely reported in 1930s. The attitude of colonial authorities toward malaria in Korea was contrasted with that in Taiwan. After Japan had set out to colonize Taiwan as a result of Sino-Japanese war, malaria in Taiwan was a big obstacle to the colonization process. Therefore, a lot of medical scientists were asked to engage the malaria research in order to handle health problems in colonized countries caused by malaria. Unlike the situation in Taiwan, malaria in Korea did not cause a serious health problem as in Taiwan. However, its risk was not negligible. In 1933 there were almost 130,000 malaria patients in Korea and 1,800 patients among them died of malaria. The Japanese Government General took measures to control malaria especially during the 1930s and the number of patients decreased. However, as Japan engaged in the World War II, the general hygienic state of the society worsened and the number of malarial patients increased. The worsened situation remains the same after Liberation (1945) and during the Korean war (1950-53).

Malaria situation analysis and stratification in Bandar Abbas Country, Southern Iran, 2004-2008

The aim of this study was that the past five years data were collected to analyze the situation of malaria and health facilities in this area for better understanding malaria problem and to find solutions. In this retrospective study data of the last 5 years were obtained from health center of Bandar Abbas, published papers and reports, weather forecasting organization of the city and annual reports of Hormozgan official authorities. An excel databank was created and analysis was conducted using this software. According to the national health system, Bandar Abbas also has referral net work system from periphery to the district health center. The maximum and minimum Annual Parasitic Index [API] were observed in 2005 [1.31] and 2008 [0.17], respectively. The prevalence of cases in villages was more than city, except for 2008. More than 97.6% of indigenous malaria cases were caused by Plasmodium vivax, although P. falciparum, P. ovale and mix infection were also reported. Anopheles stephensi, An. dthali and An. fluviatilis are the main malaria vectors in rural area, while only the first species is distributed in the urban area. According to results and many variables including API, Bandar Abbas is divided in two strata. From the situation analysis of Bandar Abbas it is postulated that the main activities of this district could be accuracy of data, and malaria vector control

A Case of Imported Plasmodium ovale malaria

There have been reports in Korea of imported malaria cases of four Plasmodium species, but there has been no report of imported Plasmodium ovale malaria confirmed by molecular biological methods. We report an imported case of that was confirmed by Wright-Giemsa-stained peripheral blood smear and nested polymerase chain reaction targeting the small subunit ribosomal RNA gene. The amplified DNA was sequenced and compared with other registered P. ovale isolates. The isolate in this study was a member of the classic type group. The patient was a 44-yr-old male who had worked as a woodcutter in Cote d'Ivoire in tropical West Africa. He was treated with hydroxychloroquine and primaquine and discharged following improvement. In conclusion, P. ovale should be considered as an etiology in the imported malaria in Korea, because the number of travelers to P. ovale endemic regions has recently increased.

Minor liver profile dysfunctions in Plasmodium vivax, P. malaria and P. ovale patients and normalization after treatment

Liver function tests were performed in 61 vivax, 54 malariae and 15 ovale malaria patients who were admitted to Bangkok Hospital for Tropical Diseases between 2001 and 2004. The objective of the study was to evaluate changes in hepatic biochemical indices before and after treatment with artemisinin derivatives. On admission and prior to treatment, hepatic dysfunction was found among the 3 groups. Serum liver function tests and physical examinations were performed weekly during the 28-day follow-up period. Initially elevated serum bilirubin and diminished albumin returned to normal within 2 weeks of treatment. Serum alkaline phosphatase and aminotransferases returned to within normal limits within 3 weeks. We conclude that patients with Plasmodium vivax, P. malariae and P. ovale infections had slightly elevated serum bilirubin, aminotransferase and alkaline phosphatase levels, and hypoalbuminemia. These minor abnormalities returned to normal within a few weeks after treatment with therapies based on artemisinin derivatives.

Automated detection of malaria: a comparison with microscopy

To compare the automated detection of malaria with microscopy. In this study 250 blood samples submitted for malaria investigation were studied microscopically for malaria parasites. All samples were additionally analyzed for same parameters with automated hematology analyzer, Cell Dyn 3700 [CD3700]. The results from the instrument generated as scatter plots [derived by laser light depolarization], were compared with microscopy results. The atypical depolarizing events or positive patterns were observed in 43 out of 250 samples on cell Dyn 3700, while microscopically 3 7 samples were found to b e positive. Three samples positive on microscopy, were found t o b e negative on CD-3700. Compared with microscopy the sensitivity of CD3700 was 92.5% and specificity was 97.3%. Maximum parasitaemia was 6.5%. Automated detection of malaria by CD3700 automated hematology analyzer is feasible for screening purpose in malaria endemic and non-endemic areas

Association of malaria with thrombocytopenia

In this study, 250 blood samples submitted for malaria investigation were studied microscopically for malarial parasites and platelet count. All samples were additionally analyzed for platelet count with automated haematology analyzer. Thirty seven [37] samples were found to be malaria positive microscopically. Out of 37 cases with malaria positive microscopically, thrombocytopenia was observed in 24 [64%] cases of malaria. So there is association of thrombocytopenia with malaria

Clinical Analysis of Malarial Infections between January and September 1998 / 대한내과학회지

OBJECTIVE: Annually, the prevalence of indigenous and imported malarial infections is steadily increasing since 1993 in Korea. In order to understand the current characteristics of malarial infections and to prevent, the present research reviewed twenty-seven cases between January and September 1998. METHOD:In this study, all the twenty-seven (twenty- six patients) cases were obtained from admitted patients between January and September 1998. We had performed routine blood chemical studies, peripheral blood thin and thick smear, physical examination and abdominal sonography. Any patient with a previous history of a narcotic drug injection or had blood transfusion was excluded. RESULTS: Twenty cases (74.1%) were indigenous and seven (25.9%) were imported malaria. Yeonchon-Gun (nine cases) was the most prevalent area in the indigenous cases; Cambodia (three cases) were the most one in the imported cases. Peripheral blood thin smear revealed Plasmodium vivax in all (100%) indigenous malaria, while four cases (57.1%) were P. vivax and one (14.3%) was P. falciparum and two (28.6%) were mixed infections with P. vivax and P. falciparum in the imported cases. In a 3-month period between July and September, peak prevalence (80.4%) was observed. The negative conversion of peripheral blood smear was achieved much earlier in the indigenous (3.9+/-1.4day) than in the imported (5.7+/-1.9day) after the treatment but, was not statistically signifcant. CONCLUSION: Plasmodium ovale was the only unique causative species in the indigenous malaria. Also Yeonchon-Gun and Cheolwon-Gun had been the most important endemic areas as previous reports. One relapse case had been occurred in the imported malaria. On the basis of our data, more efforts for control of malaria should be necessary for eradication and prevention of indigenous and imported malarial infections in Korea.

Parasitological studies of Korean forces in South Vietnam I. Examination of blood films on malaria patients

A parasitological study was performed with 452 malaria patients evacuated from South Vietnam by examinations of their peripheral blood. Results were as follows: The peripheral blood examinations revealed that 52.0% of the examined have parasitemia, of which 95.3% was P. falciparum, one case of P. vivax and the other 10 patients were mixed infected. Neither P. malaria nor P. ovale were found. A total of 1,500 thick and thin blood films was prepared and 707 slides of them (47.1%) showed positive. In P. falciparum, ring forms were found most frequently and the next was gametocytes. Eighty slides (50%) showed mixed together with both ring form and gametocytes. All of the erythrocytic stages were seen in three slides of P. vivax. Weekly periodical examinations showed 233.8 parasite density every 1,000 W.B.C count in average, while occasional at fever attacks 531.7.Size of gametocytes in P. falciparum was 9.31(+/-0.89) by 2.16(+/-0.53) in macrogametocyte and 6.61(+/-0.82) by 2.51(+/-0.35) in microgametocyte. Their sex ratio was 100 : 92. Repeated blood examinations showed increased detection rates. The positive rate of parasitemia was 52.0% in single examination, increasing in succession with repetitions.