Spontaneous splenic rupture in Plasmodium knowlesi malaria
Chee Yik Chang1, Wei Chieng Pui2, Khamisah Abdul Kadir3
1Medical Department, Kapit Hospital, Ministry of Health, Kapit, Malaysia.
Malaria Journal
|December 5, 2018
Summary
This is the first reported case of splenic rupture in Plasmodium knowlesi malaria. Early detection of this rare complication is crucial for patient survival, especially in resource-limited settings.
Area of Science:
- Tropical Medicine
- Parasitology
- Clinical Case Reports
Background:
- Plasmodium knowlesi is the most common cause of human malaria in Malaysian Borneo, originating from macaques.
- Human infections can lead to severe disease, including fatal outcomes.
- Spontaneous splenic rupture is a known severe complication of malaria, but unrecorded in P. knowlesi infections.
Observation:
- A 46-year-old male presented with symptoms of acute surgical abdomen and P. knowlesi malaria.
- Initial assessment revealed compensated shock, generalized abdominal tenderness, and free fluid on ultrasonography.
- Emergency laparotomy identified hemoperitoneum and splenic bleeding, leading to splenectomy.
Findings:
- Histopathology confirmed splenic rupture and the presence of malarial pigment.
- Nested PCR assays definitively identified P. knowlesi infection.
- The patient recovered after anti-malarial treatment and surgery.
Implications:
- This case represents the first documented instance of splenic rupture associated with P. knowlesi malaria.
- High clinical suspicion is essential for diagnosing this rare complication.
- Challenges in detection exist in healthcare facilities with limited resources.
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