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Plasmodium vivax severe imported malaria in two migrants in France.
Malaria Journal ( IF 3 ) Pub Date : 2019-12-16 , DOI: 10.1186/s12936-019-3067-5
Arezki Izri 1, 2, 3 , Sandrine Cojean 4, 5 , Claire Leblanc 6 , Yves Cohen 7 , Olivier Bouchaud 8 , Rémy Durand 1, 4
Affiliation  

BACKGROUND With less than one severe case per year in average, Plasmodium vivax is very rarely associated with severe imported malaria in France. Two cases of P. vivax severe malaria occurred in patients with no evident co-morbidity. Interestingly, both cases did not occur at the primary infection but during relapses. CASE PRESENTATIONS Patient 1: A 27-year old male, born in Afghanistan and living in France since 2012, was admitted on August 2015 to the Avicenne hospital because of abdominal pain, intense headache, fever and hypotension. The patient was haemodynamically unstable despite 5 L of filling solution. A thin blood film showed P. vivax trophozoites within the red blood cells. To take care of the septic shock, the patient was given rapid fluid resuscitation, norepinephrine (0.5 mg/h), and intravenous artesunate. Nested polymerase chain reactions of the SSUrRNA gene were negative for Plasmodium falciparum but positive for P. vivax. The patient became apyretic in less than 24H and the parasitaemia was negative at the same time. Patient 2: A 24-year old male, born in Pakistan and living in France, was admitted on August 2016 because of fever, abdominal pain, headache, myalgia, and nausea. The last travel of the patient in a malaria endemic area occurred in 2013. A thin blood film showed P. vivax trophozoites within the red blood cells. The patient was treated orally by dihydroartemisinin-piperaquine and recovered rapidly. Nine months later, the patient returned to the hospital with a relapse of P. vivax malaria. The malaria episode was uncomplicated and the patient recovered rapidly. Three months later, the patient came back again with a third episode of P. vivax malaria. Following a rapid haemodynamic deterioration, the patient was transferred to the intensive care unit of the hospital. In all the patient received 10 L of filling solution to manage the septic shock. After 5 days of hospitalization and a specific treatment, the patient was discharged in good clinical conditions. CONCLUSION Clinicians should be aware of the potential severe complications associated with P. vivax in imported malaria, even though the primary infection is uncomplicated.

中文翻译:

间日疟原虫在法国的两个移民中严重进口疟疾。

背景技术在法国,间日疟原虫平均每年少于一例,很少与严重的进口性疟疾相关。在无明显合并症的患者中发生了2例间日疟原虫严重疟疾。有趣的是,这两种情况并非在原发感染时发生,而是在复发时发生。病例介绍患者1:一名​​27岁的男性,于2012年出生在阿富汗,并于法国生活,由于腹痛,剧烈头痛,发烧和低血压,于2015年8月入Avicenne医院。尽管有5 L填充溶液,但患者的血流动力学不稳定。薄的血膜显示红细胞内的间日疟原虫滋养体。为了治疗败血性休克,给患者进行了快速的液体复苏,去甲肾上腺素(0.5 mg / h)和静脉注射青蒿琥酯。SSUrRNA基因的嵌套式聚合酶链反应对恶性疟原虫呈阴性,但对间日疟原虫呈阳性。患者在不到24H的时间内出现退热,同时寄生虫血症为阴性。病人2:一名24岁的男性,出生于巴基斯坦,居住在法国,由于发烧,腹痛,头痛,肌痛和恶心,于2016年8月入院。患者在疟疾流行地区的最后一次旅行发生在2013年。薄薄的血膜显示红细胞内的间日疟原虫滋养体。该患者经双氢青蒿素-哌喹口服治疗,并迅速康复。九个月后,患者因间日疟原虫疟疾复发而返回医院。疟疾发作并不复杂,患者迅速康复。三个月后,患者再次发作第三次P。间日疟。血液动力学迅速恶化后,患者被转移到医院的重症监护室。所有患者接受10 L灌装液以控制败血性休克。经过5天的住院治疗和特殊治疗,患者在良好的临床条件下出院。结论即使原发感染并不复杂,临床医生也应意识到与间日疟原虫相关的潜在严重并发症。
更新日期:2019-12-16
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