Severe malaria in a splenectomised Gabonese woman

The intact splenic function is of utmost importance for the host's defence capacity against Plasmodium spp. not only by limiting the acute infection through the removal of parasites from the blood stream, but also by modulating parasite antigen expression on the surface of infected red blood cells as well as cellular and humoral immune response. Splenectomised individuals are at high risk to develop a more severe and prolonged disease, even if they had acquired semi-immunity prior to their loss of splenic tissue.

We report on a 37 year old splenectomised Gabonese woman who developed severe falciparum malaria with hyperparasitaemia, profound anaemia, and an overwhelming gametocytaemia, recovering very slowly following quinine therapy. Whereas the clinical course is not at odds with previous descriptions, the massive occurrence of mature gametocytes as documented here has not been reported before. Whether the high gametocyte count observed in our patient was primarily due to the impaired clearance of asexual forms or to the induction of gametocytogenesis remains unclear. Regarding the optimal drug regimen for treating malaria in splenectomized patients, a combination of an aminoquinoline with an artemisinin derivative might be the optimal choice.