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A Case of Mixed Malaria Infection with Severe Hemolytic Anemia after Travel to Angola
Sang-Yong Shin1, Jung-hee Yu2, Jung-Yeon Kim3, Yeon-Ju Kim3, Hee-Yeon Woo1, Min-Jung Kwon1, and Joon-Sup Yeom2
Departments of 1Laboratory Medicine and 2Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul; Division of Malaria and Parasitic Diseases3, Korea Centers for Disease Control and Prevention, Osong, Korea
In Korea, Plasmodium vivax (P. vivax) is the most common agent of malaria infection. However, as travel to regions where malaria is endemic increases, so do the numbers of Plasmodium falciparum and mixed infections. P. falciparum predominates, while P. vivax is rare in west-central Africa. We report on a case of mixed malaria infection with severe hemolytic anemia caused by P. falciparum and P. vivax in a 38-yearold man after traveling to Angola. A diagnosis of P. falciparum malaria was made by microscopic examination. However, both P. vivax and P. falciparum were detected by the polymerase chain reaction (PCR). As a radical cure P. vivax , the patient was treated with mefloquine, artemether, and primaquine. Both P. falciparum and P. vivax had disappeared from peripheral blood by admission day 4, however, low grade fever and headache persisted, and his hemoglobin and hematocrit levels were depleted. A peripheral blood smear was negative for both P. vivax and P. falciparum; however, a direct anti-globulin test and anti-nuclear antibody test were positive, suggesting immune hemolytic anemia. After conservative treatment, which included a transfusion with packed red blood cells (RBC), his symptoms and signs showed improvement and laboratory findings were normalized.
Keywords : Plasmodium falciparum, Plasmodium vivax , Mixed infection