Clinical and Laboratory Features of Human Plasmodium knowlesi Infection
Background—Plasmodium knowlesi is increasingly recognized as a cause of human malaria in Southeast Asia but there are no detailed prospective clinical studies of naturally acquired infections. Methods—In a systematic study of the presentation and course of patients with acute P. knowlesi infecti...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Infectious Diseases Society of America
2009
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| Subjects: | |
| Online Access: | http://ir.unimas.my/id/eprint/15807/1/Davis%2C%20T.M.E.pdf http://ir.unimas.my/id/eprint/15807/ https://www.researchgate.net/publication/26698074_Clinical_and_Laboratory_Features_of_Human_Plasmodium_knowlesi_Infection |
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| Summary: | Background—Plasmodium knowlesi is increasingly recognized as a cause of human malaria in
Southeast Asia but there are no detailed prospective clinical studies of naturally acquired
infections.
Methods—In a systematic study of the presentation and course of patients with acute P. knowlesi
infection, clinical and laboratory data were collected from previously untreated, nonpregnant
adults admitted to the hospital with polymerase chain reaction–confirmed acute malaria at Kapit
Hospital (Sarawak, Malaysia) from July 2006 through February 2008.
Results—Of 152 patients recruited, 107 (70%) had P. knowlesi infection, 24 (16%) had
Plasmodium falciparum infection, and 21 (14%) had Plasmodium vivax. Patients with P. knowlesi
infection presented with a nonspecific febrile illness, had a baseline median parasitemia value at
hospital admission of 1387 parasites/μL (interquartile range, 6–222,570 parasites/μL), and all
were thrombocytopenic at hospital admission or on the following day. Most (93.5%) of the
patients with P. knowlesi infection had uncomplicated malaria that responded to chloroquine and
primaquine treatment. Based on World Health Organization criteria for falciparum malaria, 7
patients with P. knowlesi infection (6.5%) had severe infections at hospital admission. The most
frequent complication was respiratory distress, which was present at hospital admission in 4
patients and developed after admission in an additional 3 patients. P. knowlesi parasitemia at
hospital admission was an independent determinant of respiratory distress, as were serum
creatinine level, serum bilirubin, and platelet count at admission (P < .002 for each). Two patients
with knowlesi malaria died, representing a case fatality rate of 1.8% (95% confidence interval,
0.2%–6.6%).
Conclusions—Knowlesi malaria causes a wide spectrum of disease. Most cases are
uncomplicated and respond promptly to treatment, but approximately 1 in 10 patients develop
potentially fatal complications. |
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