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Autochthonous Plasmodium vivax malaria in a Greek schoolgirl of the Attica region.

Loupa CV, Tzanetou K, Kotsantis I, Panopoulos S, Lelekis M - Malar. J. (2012)

Bottom Line: In August 2009, one case of autochthonous malaria due to Plasmodium vivax was diagnosed in Greece in a young woman residing in the Eastern Attica region.No other autochthonous malaria cases have been described in the Attica region since 1974.This was a sporadic case with no evidence of further local transmission, and no more cases have been reported in Attica up to now, two years later.

View Article: PubMed Central - HTML - PubMed

Affiliation: 2nd Department of Internal Medicine, A, Fleming General Hospital, 14 25th March St,, Melissia, Athens GR-15127, Greece. ch-loupa@hol.gr

ABSTRACT
In August 2009, one case of autochthonous malaria due to Plasmodium vivax was diagnosed in Greece in a young woman residing in the Eastern Attica region. The source of infection could not be identified. No other autochthonous malaria cases have been described in the Attica region since 1974. This was a sporadic case with no evidence of further local transmission, and no more cases have been reported in Attica up to now, two years later.

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Plasmodium vivax in Giemsa-stained thin blood smear with all developmental stages present in peripheral blood. (A) Growing amoeboid trophozoite in enlarged red blood cell (RBC) with eosinophilic stippling (schuffner's dots). (B) Immature schizonts with clumps of brown pigment almost fill the enlarged RBCs. (C) Mature schizont with merozoites (about 14) and clumped pigment. (D) Macrogametocyte with diffuse brown pigment and eccentric compact chromatin.
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Figure 1: Plasmodium vivax in Giemsa-stained thin blood smear with all developmental stages present in peripheral blood. (A) Growing amoeboid trophozoite in enlarged red blood cell (RBC) with eosinophilic stippling (schuffner's dots). (B) Immature schizonts with clumps of brown pigment almost fill the enlarged RBCs. (C) Mature schizont with merozoites (about 14) and clumped pigment. (D) Macrogametocyte with diffuse brown pigment and eccentric compact chromatin.

Mentions: A 17-year-old young woman of Greek origin, living in the Eastern Attica region, was admitted to hospital (mid-August, 2009), because of high fever (up to 40.3°C) of abrupt onset with chills for eight days. She also reported sore throat, headache, remarkable weakness and sweating with unpleasant smell. Fever was almost periodic, being higher every second day. Anti-pyretic drugs were causing lysis with excess sweating. Her past medical history was unremarkable. She denied travelling abroad and had no history of blood transfusion. Upon admission, patient was in good condition, and physical examination revealed mild hepatosplenomegaly. There were multiple skin lesions suggesting insect bites, especially on lower limbs. During the first 48 hours of hospitalization, she had fever up to 40°C, symptomatically treated with paracetamol. Initial blood evaluation showed normocytic, normochromous anaemia (haematocrit 31.3%, MCV = 89.6 fL, MCHC = 32.3), thrombocytopaenia (platelets 48,000/μL), with a normal leukocyte count. Liver function tests yielded slightly abnormal results: AST 28 u/L, ALT 71 u/L (reference range < 40), LDH 943 u/L (reference range 230-450), and total bilirubin 1.2 mg/dL (reference range < 1,0). Kidney function tests and coagulation study were normal. ESR was 58 mm, and CRP 139 mg/L (reference range < 5). Chest x-ray and urinalysis were normal. Two sets of blood cultures and urine culture were negative. Viral (cytomegalovirus, Epstein-Barr virus), bacterial (brucella) and parasitic (Toxoplasma, Leishmania) serology was negative, and throat swab PCR for H1N1 antigens was also negative. Based on serology (Ra-test, ANA, anti-DNA), there was no evidence of systemic disease. Ultrasonography of the upper abdomen showed enlarged liver and spleen (17.2 and 14.1 cm, respectively). The initial Giemsa-stained peripheral blood smear was negative for Plasmodium. In a second peripheral blood smear, obtained on the third hospital day, Plasmodium parasites were identified. The patient was started on mefloquine. When the smear was re-examined by an experienced microbiologist, the parasite was identified as Plasmodium vivax according to morphological characteristics of trophozoites, immature/mature schizonts, and gametocytes (Figure 1A-D). Parasitaemia was approximately 3%. After completing mefloquine therapy (750 mg po ×1, then 500 mg po × 1 12 h later), the patient's condition improved and after assessment of G-6-PD levels, she was discharged on primaquine (30 mg base po ×1) for 14 days. Seen as an outpatient, she remains in good health and relapse-free to September 2011 (two years after discharge).


Autochthonous Plasmodium vivax malaria in a Greek schoolgirl of the Attica region.

Loupa CV, Tzanetou K, Kotsantis I, Panopoulos S, Lelekis M - Malar. J. (2012)

Plasmodium vivax in Giemsa-stained thin blood smear with all developmental stages present in peripheral blood. (A) Growing amoeboid trophozoite in enlarged red blood cell (RBC) with eosinophilic stippling (schuffner's dots). (B) Immature schizonts with clumps of brown pigment almost fill the enlarged RBCs. (C) Mature schizont with merozoites (about 14) and clumped pigment. (D) Macrogametocyte with diffuse brown pigment and eccentric compact chromatin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351731&req=5

Figure 1: Plasmodium vivax in Giemsa-stained thin blood smear with all developmental stages present in peripheral blood. (A) Growing amoeboid trophozoite in enlarged red blood cell (RBC) with eosinophilic stippling (schuffner's dots). (B) Immature schizonts with clumps of brown pigment almost fill the enlarged RBCs. (C) Mature schizont with merozoites (about 14) and clumped pigment. (D) Macrogametocyte with diffuse brown pigment and eccentric compact chromatin.
Mentions: A 17-year-old young woman of Greek origin, living in the Eastern Attica region, was admitted to hospital (mid-August, 2009), because of high fever (up to 40.3°C) of abrupt onset with chills for eight days. She also reported sore throat, headache, remarkable weakness and sweating with unpleasant smell. Fever was almost periodic, being higher every second day. Anti-pyretic drugs were causing lysis with excess sweating. Her past medical history was unremarkable. She denied travelling abroad and had no history of blood transfusion. Upon admission, patient was in good condition, and physical examination revealed mild hepatosplenomegaly. There were multiple skin lesions suggesting insect bites, especially on lower limbs. During the first 48 hours of hospitalization, she had fever up to 40°C, symptomatically treated with paracetamol. Initial blood evaluation showed normocytic, normochromous anaemia (haematocrit 31.3%, MCV = 89.6 fL, MCHC = 32.3), thrombocytopaenia (platelets 48,000/μL), with a normal leukocyte count. Liver function tests yielded slightly abnormal results: AST 28 u/L, ALT 71 u/L (reference range < 40), LDH 943 u/L (reference range 230-450), and total bilirubin 1.2 mg/dL (reference range < 1,0). Kidney function tests and coagulation study were normal. ESR was 58 mm, and CRP 139 mg/L (reference range < 5). Chest x-ray and urinalysis were normal. Two sets of blood cultures and urine culture were negative. Viral (cytomegalovirus, Epstein-Barr virus), bacterial (brucella) and parasitic (Toxoplasma, Leishmania) serology was negative, and throat swab PCR for H1N1 antigens was also negative. Based on serology (Ra-test, ANA, anti-DNA), there was no evidence of systemic disease. Ultrasonography of the upper abdomen showed enlarged liver and spleen (17.2 and 14.1 cm, respectively). The initial Giemsa-stained peripheral blood smear was negative for Plasmodium. In a second peripheral blood smear, obtained on the third hospital day, Plasmodium parasites were identified. The patient was started on mefloquine. When the smear was re-examined by an experienced microbiologist, the parasite was identified as Plasmodium vivax according to morphological characteristics of trophozoites, immature/mature schizonts, and gametocytes (Figure 1A-D). Parasitaemia was approximately 3%. After completing mefloquine therapy (750 mg po ×1, then 500 mg po × 1 12 h later), the patient's condition improved and after assessment of G-6-PD levels, she was discharged on primaquine (30 mg base po ×1) for 14 days. Seen as an outpatient, she remains in good health and relapse-free to September 2011 (two years after discharge).

Bottom Line: In August 2009, one case of autochthonous malaria due to Plasmodium vivax was diagnosed in Greece in a young woman residing in the Eastern Attica region.No other autochthonous malaria cases have been described in the Attica region since 1974.This was a sporadic case with no evidence of further local transmission, and no more cases have been reported in Attica up to now, two years later.

View Article: PubMed Central - HTML - PubMed

Affiliation: 2nd Department of Internal Medicine, A, Fleming General Hospital, 14 25th March St,, Melissia, Athens GR-15127, Greece. ch-loupa@hol.gr

ABSTRACT
In August 2009, one case of autochthonous malaria due to Plasmodium vivax was diagnosed in Greece in a young woman residing in the Eastern Attica region. The source of infection could not be identified. No other autochthonous malaria cases have been described in the Attica region since 1974. This was a sporadic case with no evidence of further local transmission, and no more cases have been reported in Attica up to now, two years later.

Show MeSH
Related in: MedlinePlus