Severe knowlesi malaria with acute neurocognitive impairment: A case report

Plasmodium knowlesi infection in Indonesia has been reported from Sumatera and Kalimantan Island. P. knowlesi has the shortest asexual replication cycle of all Plasmodium species, leading to rapidly increased parasitemia levels; however, it usually does not cause high parasitemia. It was reported a severe knowlesi malaria case in a 41-year-old male patient in Samarinda, East Kalimantan Province, Indonesia. The patient was admitted to the hospital with fever and decrease in level of consciousness. Malarial blood smear showed trophozoites and ring forms of P. knowlesi, with parasite count 52,000/µl blood, and confirmed by polymerase chain reaction test. The patient was diagnosed as having severe knowlesi malaria with a high parasitemia level, accompanied by acute neurocognitive impairments, including moderate weakness, disorientation, and partial loss of memory that lasted for approximately 3 weeks.