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- Title
Human Plasmodium knowlesi: an emerging infection presented with severe thrombocytopenia.
- Authors
Mohamed Z; Roshan TM
- Abstract
Malaria remains an important vector-borne disease in a rural Malaysian area. There are chances of missing the diagnosis of malaria due to high prevalence of dengue in the region especially when patients presented with thrombocytopenia. Severe thrombocytopenia is common in isolated P. falciparum, mixed P. falciparum and P. vivax infection. However it is not reported in the cases of P. knowlesi. Here, we report a case of severe thrombocytopenia (platelet count of less than 20 X 109/L) with P. knowlesi infection. Patient's initial working diagnosis was dengue fever however dengue serology was repeatedly negative for IgM and IgG. Suspicion of malaria infection only arose after examination of full blood picture showing late trophozoite stages that had mixed features of P. malariae and P. falciparum. The diagnosis of P. knowlesi was confirmed by polymerase chain reaction (PCR). It was the first reported case of P. knowlesi which presented with severe thrombocytopenia in this part of Malaysia. The patient responded well to anti-malarial therapy and his platelet count recovered completely within one week. We highlighted two important issues: Clinician must not ignore malaria as one of the causes of thrombocytopenia and P. knowlesi infection can easily be missed diagnosed as P. malariae or P. falciparum depending upon the stage of parasite seen in the peripheral blood. Due to similarities in the morphology we recommend that all diagnosed cases of P. malariae with atypical presentation should be subjected to PCR specific to P. knowlesi in this part of Malaysia.
- Publication
International Medical Journal, 2009, Vol 16, Issue 4, p307
- ISSN
1341-2051
- Publication type
Journal Article