DOI: https://doi.org/10.21203/rs.3.rs-2385165/v1
Malaria continues to be a significant global public health problem, particularly in endemic nations. A 28-year-old male was brought into the emergency room with significant complaints of fatigue, chills, fever, and lack of appetite. The patient had no prior history of malaria. He was not given any anti-malarial medication as prophylaxis while traveling to his workplace. As a result of laboratory investigations to identify malarial parasites in peripheral blood using thin and thick smears, malaria parasites were found in the patient. Cardiovascular testing confirmed that S1 and S2 were audible. At the border of the colitis, the liver was palpable. Both the chest X-ray and abdominal ultrasonography were clear. His level of consciousness assessment indicated a Glasgow coma scale reading of 10 out of 15. As part of her supportive care, he received 1000 mL of normal saline solution with 40% glucose solution. He received intravenous artesunate 60 mg (2.4 mg/kg) when he was admitted to the intensive care unit, and then every twelve and twenty-four hours for the following three days (a total of three doses, 540 mg).
Malaria is an Italian word composed of "mala" and "aria", derived from malus (bad) and aeris (air). It is a disease brought on by a protozoan parasite of the genus Plasmodium, namely P. falciparum, P. vivax, P. malariae, and P. ovale [1]. Travelers from northern countries returning from malaria-endemic areas are still at high risk of contracting Plasmodium falciparum malaria [2]. Plasmodium falciparum is often linked to acute renal failure, but Plasmodium malariae has been linked to chronic progressive renal failure [3]. Plasmodium falciparum infection increases the risk of developing severe malaria, which can cause clinical consequences such as coma, renal failure, respiratory distress, or even death [4]. If the infection is not detected and treated in a timely manner, travelers returning from endemic areas run the risk of developing severe malaria [5]. According to the World Health Organization, artesunate is the first-line therapy for both adults and children with severe malaria in endemic countries [6]. In this case report, the rapid renal failure caused by severe malaria in a middle-aged patient is described.
A 28-year-old male was brought into the emergency room with significant complaints of fatigue, chills, fever, and lack of appetite. The patient was hospitalized after experiencing joint discomfort, a dry cough, and epigastric burning for three days prior to admission. The patient complained of deteriorating symptoms, such as fatigue and an epigastric burning sensation, on the day of admission. He had some sense of direction, was awake, and could speak well. One year ago, the patient visited malarious area for business. There was no prior history of malaria in the patient. He was not given any anti-malarial medication while traveling to his workplace. His vital signs revealed a 38.1 oC body temperature, a blood pressure of 121/77 mm Hg, and a heart rate of 101 beats per minute.While inhaling room air, the patient's oxygen saturation was 96%.
His laboratory investigations revealed a hemoglobin level of 13.7 g/dL, a hematocrit of 38.4%, blood urea nitrogen of 43 mg/dL, fasting blood glucose of 117 mg/dL, an aspartate aminotransferase level of 47 units/L, an alanine aminotransferase level of 40 units/L, an erythrocyte sedimentation rate of 13 mm/hour, a white blood cell count of 4,850/mL, a platelet count of 61,400/mm3, a serum creatinine level of 2.7 mg/dL, neutrophils of 87%, lymphocytes of 7%, and monocytes of 1%. Other serum electrolytes, including serum liver enzymes, except serum potassium and sodium levels, were found to be within the normal range. As a result of laboratory investigations to identify malarial parasites in peripheral blood using thin and thick smears, malaria parasites were found in the patient. He was sent to an urgent care facility after being diagnosed with severe malaria after peripheral thin blood film discovered P. falciparum trophozoites.
Cardiac and pulmonary sounds were normal. Examination of the head, eyes, ears, nose, and throat revealed a swollen face with pink conjunctiva. Cardiovascular testing confirmed that S1 and S2 were audible. At the border of the costa, the liver was palpable. Both the chest X-ray and abdominal ultrasonography were clear. His level of consciousness assessment indicated a Glasgow coma scale reading of 10 out of 15. His electrocardiogram revealed sinus tachycardia with an ST-segment of 0.07 seconds and a heart rate of 114 beats per minute. He had a big, round, non-tender belly that was dull but not organomegalic.
He received 1000 ml of normal saline solution with 40% glucose solution as supportive care for her condition. When he was admitted to the critical care unit and at intervals of twelve and twenty-four hours for the next three days, he received intravenous artesunate 60 mg (2.4 mg/kg). The patient was shifted to oral dosages of 20 mg artemether and 120 mg lumefantrine, four tablets twice a day for three days following the final dose of artesunate (a total of three doses, 540 mg).
After four days in the hospital, he made a partial recovery and was eventually released after clinical and laboratory tests revealed a noticeable improvement. He gave advice as he would visit a nearby clinic in a month.
Plasmodium falciparum is the parasite that causes severe malaria, which presents as severe anemia, renal failure, acute respiratory failure, hypoglycemia, shock, and/or involvement of the central nervous system [7]. Indicators of Plasmodium falciparum malaria presentation symptoms and death patterns include geographic distribution, the level of parasite transmission, and host immunity to the parasite [8]. In this study, the patient traveled to a region with the greatest frequency of malaria since he had a job there, where Plasmodium falciparum is a frequent infection that can have serious health effects.
A female Anopheles mosquito that has been infected spreads the parasite. The illness remains the leading cause of morbidity and mortality in many tropical poor countries where it is primarily caused by Plasmodium falciparum [9].The study participant was not given antimalarial prophylaxis when he was traveling to his workplace. He had been bitten by Plasmodium falciparum-infected mosquitoes, placing him at high risk for developing severe malaria and its consequence, acute kidney damage. In this study, the patient contracts Plasmodium falciparum in three stages. The first stage is infecting the liver cells, then the blood cells, and finally producing gametes that might be transmitted by mosquitoes.
Malaria has a variety of clinical symptoms, and the development of these clinical manifestations is influenced by host, parasite, and social and geographic variables. Asymptomatic infections, acute febrile illnesses, severe malaria, and fatal cases are all on the clinical spectrum [10]. The patient in this study had a wide range of malarial signs and symptoms, such as joint pain, nausea, vomiting ingested material, chills, flank pain, fever, tiredness, and nausea.
In regions with active transmission, Plasmodium falciparum is noticed as a significant contributor to acute renal damage [11]. Adults with severe malaria frequently experience acute renal damage, which can impact up to 40% of patients [12]. The mechanism proposed for kidney injury by severe malaria is hemodynamic dysfunction, followed by inflammation and immunological dysregulation in the patient in this study. He had reduced serum sodium levels within the red cells, which led to calcium influx into the cell, altering the red cell's deformability.
As the first-line treatment for severe and complex malaria, parenteral artesunate is advised [13]. When artesunate is contraindicated or when the only reason for parenteral medication is intolerance to oral therapy, parenteral quinine is the alternative treatment [14]. In this study, the patient received 60 mg (2.4 mg/kg) of artesunate intravenously at the time of admission to the critical care unit and then every twelve and twenty-four hours for three days. The patient was shifted to oral dosages of 20 mg artemether and 120 mg lumefantrine, four tablets twice a day for three days following the final dose of artesunate (a total of three doses of 540 mg).
Malaria becomes severe when catastrophic organ failures, abnormalities in the patient's blood, or abnormalities in their metabolism combine with infectious conditions. A typical symptom of severe malaria is acute kidney damage, which also carries its own risk of mortality. The drug of choice for treating severe malaria caused by Plasmodium falciparum is parenteral artesunate.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report.
Acknowledgments
The author is grateful to the study participant for his willingness to respond all questions.
Funding
None
Competing interests
The author has no financial or proprietary interest in any of material discussed in this article.