1. FULMINANT CEREBRAL MALARIA IN A SWISS PATIENT
K. Mühlethaler 1, E. Scheurer 2, U. Zollinger 2, R. Markwalder 3, X.M. Nguyen 1
1 Institute for Infectious Diseases, 2 Institute of Forensic Medicine, 3 Institute for Pathology
University of Berne, Switzerland
Objective:
Malaria remains the most important parasitic disease worldwide. Falciparum
malaria is a medical emergency and requires immediate diagnosis and
treatment. Cerebral malaria is a rapidly progressive, potentially fatal
complication of Plasmodium falciparum infection. We present this case as a
reminder to those colleagues not regularly confronted with such situations.
Spleen: congested white and red pulpa, parasites in red blood cells and sinusoids (HE, 250x)
Liver: Trophozoites in Kupffer cells and sinusoides (HE, 250x)
2. Postmortem findings (forensic autopsy):
massive congestion and edema of brain, lungs and other inner
organs
spleen enlarged (570 g), with tense, smooth capsule and congested
parenchyma of brown-black color
Methods / Investigations:
1. Clinical history:
34-year old, white male, spent 8 days close to Mombassa (Kenya)
last minute flight  no time to seek pre-travel health advice, departure
without arranging chemo prophylaxis
11 days after returning to Switzerland: abrupt onset of fever, chills,
malaise and muscle aches
3 days later patient treated for influenza by a general practitioner
patient died 4 days afterwards due to multiple organ failure
Brain: massive congestion and edema
3. Laboratory diagnosis:
EDTA preserved blood was collected postmortem; due to lysis
percentage parasitaemia was not done
In thick & thin Giemsa stained blood: numerous trophozoites
Plasmodium falciparum antigen (HRP2, aldolase) detected
(immunochromatographic assay)
Histology: brain/liver/spleen: vessels plugged with parasitized
red cells, each containing hemozoin pigment
Brain: neuron and congested vessels with trophozoites in red blood cells (Giemsa, oil 40x)
Brain: capillaries plugged with trophozoites in red blood cells (HE 250x)
Conclusion:
Necessity of obtaining appropriate pre-travel health advice on malaria
prophylaxis before departure to endemic area
Malaria should always be considered in the differential diagnosis of patients
presenting with fever and/or nonspecific symptoms who have travelled to
endemic countries
Thick blood smear (Giemsa, 100x)
Thin blood smear (Giemsa, 100x)
Plasmodium falciparum antigen
Correspondence:
Dr. K. Muehlethaler, Institute for Infectious Diseases (Clinical Microbiology)
University of Berne, CH-3010 Berne, Switzerland
Tel
10th ICOPA, 4-9 August, 2002 – Vancouver, Canada