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Chest Infections |

Severe Falciparum Malaria Complicated by Disseminated Aspergillosis

Suresh Uppalapu, MD; Samir Sultan, DO; Gregory Chu, MD
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Banner Good Samaritan Regional Medical Center, Phoenix, AZ


Chest. 2014;145(3_MeetingAbstracts):113A. doi:10.1378/chest.1835175
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Abstract

SESSION TITLE: Infectious Disease Case Reports Posters III

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Falciparum Malaria is associated with transient immunosuppression resulting in disseminated fungal infections like aspergillosis. Ineffective phagocyotosis by alveolar macrophages was implicated as the pathogenetic mechanism leading to disseminated fungal infections. So far 4 cases were reported in the literature of severe falciparum malaria associated with disseminated aspergillosis. We present the first documented case of malaria observed in different stages on bronchoalveolar lavage with underlying disseminated aspergillosis.

CASE PRESENTATION: 55 years old Sudanese male admitted to our hospital ICU intubated and in shock state. Patient returned from Sudan three weeks ago prior to his presentation. The past medical/surgical history was notable for splenectomy for hypersplenism, but no history of an immunocompromised state. Diagnosis at the time of admission was severe falciparum malaria with multi organ failure. Aggressive supportive care along with malaria specific therapy was initiated. The parasite load decreased from 19.6% on admission to 1% after implementation of exchange transfusion. Patient then developed profuse endobronchial hemorrhage with clots needing therapeutic bronchoscope and dislodgement of the clots. Broncho alveolar lavage done was sent for analysis. After initiation of malaria treatment, patient showed clinical improvement, but continued to have hemoptysis needing repeated bronchoscopies and bronchial artery embolization. His clinical condition worsened necessitating escalation of antimicrobial regimen. At that point, serological studies were sent for Aspergillus Fumigatus. On day 10 of his arrival to the hospital he passed away despite aggressive treatments. Autopsy revealed disseminated Aspergillus Fumigatus to multiple organs which included lung, heart, liver, small bowel.

DISCUSSION: This case presents a unique challenge to health care providers as his presentation was life threatening malaria but his eventual cause of death seemed to be disseminated Aspergillosis. As with other previously reported cases, his underlying disseminated aspergillosis became clinically apparent after the treatment of malaria.

CONCLUSIONS: Severe malaria infections can lead to other life threatening fungal infections leading to fatality. High index of clinical suspicion with broad anti microbial coverage should be the treatment approach in dealing with cases of severe malaria.

Reference #1: Isabella Eckerlie, Damaris Ebinger, Gotthardt, R.Eberhardt et all.Invasive Aspergillosis fumigatus infection after plasmodium Falciparum malaria in an Immuno competent host: Case report and review of literature. Malaria Journal 2009, 8:167.

Reference #2: Hocqueloux L, Bruneel F, Pages CL, Vachon F. Fatal Invasive Aspergillosis complicating Severe Plasmodium Falciparum Malaria.Clinical infectious disease 200 Jun: 30(6): 940-2.

Reference #3: Ruhnke M, Eichenauer E, Searle J, Lippek F. Fulminant tracheo bronchial and pulmonary aspergillosis complicating imported plasmodium malaria in an apparently immunocompetent woman. Clinical infectious disease Jun: 30(6) 938-40.

DISCLOSURE: The following authors have nothing to disclose: Suresh Uppalapu

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