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Sudden spleen rupture in a Plasmodium vivax-infected patient undergoing malaria treatment

By Pierre Bush, PhD Moderator | 14 Feb, 2018

Dear Colleagues,
Here is an interesting case (written by Elizalde-Torrent et al., 2018) of a sudden spleen rupture due Plasmodium vivax. How many of you have seen cases like this one and what is your management advise?
Thank you.
Highest Regards,
Abstract

Background

Splenomegaly is one of the most common features of malaria. However, spontaneous splenic rupture, although unusual, represents a severe complication often leading to death. It is mostly seen in acute infection and primary attack, and it is most commonly associated with Plasmodium vivax. Here, a case of spontaneous splenic rupture diagnosed with a portable ultrasound apparatus shortly after starting treatment and with recurrent parasitaemia after splenectomy, is reported.

Case description

In November 2015, a 45-year-old Brazilian man presented to the hospital in Manaus with fever, headache and myalgia. He was diagnosed with P. vivax malaria and, after a normal G6PD test, he started treatment with chloroquine and Primaquine and was discharged. Two days later, he went back to the hospital with abdominal pain, dyspnea, dry cough, pallor, oliguria and fever. Using a portable ultrasound, he was diagnosed of rupture of the spleen, which was removed by emergency surgery. After this episode, he suffered two more malaria episodes with high parasitaemia at approximately 2-month intervals. DNA from different portions of the spleen was extracted and a qualitative PCR was performed to detect P. vivax.

Conclusions

The splenic rupture suffered by this patient occurred 2 days after starting the treatment. Having a portable ultrasound apparatus may have saved the patient’s life, as it revealed a haemorrhage needing an urgent surgery. Parasites were detected by PCR in the extracted spleen. This patient suffered two more vivax malaria diagnosed episodes in spite of receiving and completing treatment with chloroquine and Primaquine for each clinical attack. Splenic rupture during acute malaria is uncommon, but it is likely underdiagnosed and underreported, because the lack of means and equipment hinders diagnostic confirmation, especially in endemic areas.

Attached resource:

Replies

 

Ahishakiye Alain Replied at 12:06 AM, 15 Feb 2018

Thanks dear Bush. It is an interesting article. It is thé first Time to
hear that sudden rupture of the spleen could happen during an acute malaria
vivax. In our area we have malaria due to falciparum and usually there is
tropical spleen second to chronic épisodes of malaria but no acute episode
with sudden spleen rupture. I don't Know if it is for malaria vivax only.

Joyce Bartekwa Replied at 2:59 AM, 15 Feb 2018

Very interesting!

Kamiludeen Hassan Replied at 4:09 PM, 16 Feb 2018

Very interesting, thanks for sharing.

Massada Rocha Replied at 12:55 AM, 17 Feb 2018

Kamiludeen Hassan via GHDonline <> escreveu em sex,
16/02/2018 às 23:16 :

Gonzo Manyasi Replied at 4:20 AM, 17 Feb 2018

Dr Bush, thanks for sharing this. As remarkable as the occurrence of the splenic rupture phenomenon is, it was the last part of the conclusion part of the abstract that says "...but it is likely underdiagnosed and underreported, because the lack of means and equipment hinders diagnostic confirmation, especially in endemic areas." that particularly caught my attention even more. Mostly because it's what resonates with the situation in my country Kenya where those not near the few referral hospitals (found in the regional or provincial capitals) are more or less doomed. The emphasis on having appropriate and functioning equipment in far flung endemic areas cannot be overstated, even if of the portable kind (that can be shared among neighbouring facilities) which in this case may have saved the patient's life!

Christiana Sarfoa Replied at 8:45 AM, 17 Feb 2018

Very interesting!

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