Diagnostic challenges and case management of the first imported case of Plasmodium knowlesi in Sri Lanka

Malaria Journal

Case Report

Hema D. B. Herath¹  W. M. Kumudunayana T. de A. W. Gunasekera¹  Priyani Dharmawardena¹  A. Dewanee Ranaweera¹  Manjula N. Danansuriya¹  Deepika Fernando²  Cheong Huat Tan³  Keng Wai Mak³  Mei-Zhi Irene Li³  Pei-Sze Jeslyn Wong³  Hapuarachchige C. Hapuarachchi³  Kusumawathie Pahalagedera⁴ 

[1] Anti Malaria Campaign, 555/5, Public Health Complex, Narahenpita, Colombo 5, Sri Lanka;Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka;Environmental Health Institute, National Environmental Agency, 11 Biopolis Way, #06-05/08, 138667, Singapore, Singapore;Regional Office, Anti Malaria Campaign, Dutugemunu Mawatha, Watapuluwa, Kandy, Sri Lanka;

关键词: Malaria;    Plasmodium knowlesi;    Sri Lanka;    Imported;    Surveillance;   

DOI  :  10.1186/s12936-017-1776-1

 received in 2017-01-10, accepted in 2017-03-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundSri Lanka has achieved ‘malaria-free’ status and is now in the phase of prevention of re-introduction of malaria. Imported malaria remains a challenge to resurgence of the disease. The diagnostic challenges encountered and the rapid response initiated to manage a Plasmodium infection, which was later confirmed as Plasmodium knowlesi, the first reported case from Sri Lanka, is discussed.Case presentationAn army officer who returned from Malaysia in October 2016 was found to be positive for Plasmodium both by microscopy and rapid diagnostic test (RDT) by the Anti Malaria Campaign Sri Lanka (AMC) during his third visit to a health care provider. Microscopy findings were suspicious of P. knowlesi infection as the smears showed parasite stages similar to both Plasmodium malariae and Plasmodium falciparum. Nested PCR at AMC confirmed Plasmodium genus, but not the species. In the absence of species confirmation, the patient was treated as a case of P. falciparum. The presence of P. knowlesi was later confirmed by a semi-nested PCR assay performed at the Environmental Health Institute, National Environmental Agency in Singapore. The parasite strain was also characterized by sequencing the circumsporozoite gene. Extensive case investigation including parasitological and entomological surveillance was carried out.ConclusionsPlasmodium knowlesi should be suspected in patients returning from countries in the South Asian region where the parasite is prevalent and when blood smear results are inconclusive.

【 授权许可】

CC BY   
© The Author(s) 2017