Case Report: Histopathology of Fatal Respiratory Distress Caused by Plasmodium vivax Malaria

Authors

Neena Valecha, National Institute of Malaria Research
Rock G.W. Pinto, Department of Pathology, Goa Medical College
Gareth D.H. Turner, Department of Cellular Pathology, Level 1, John Radcliffe Hospital, Oxford
Ashwani Kumar, National Institute of Malaria Research, Field Unit, Directorate of Health Services Building
Savio Rodrigues, Department of Microbiology, Goa Medical College and Hospital
Nagesh G. Dubhashi, Department of Medicine, Goa Medical College and Hospital
Edmond Rodrigues, Department of Forensic Medicine, Goa Medical College and Hospital
Sidhartha S. Banaulikar, Department of Forensic Medicine, Goa Medical College and Hospital
Ruchi Singh, National Institute of Malaria Research
Aditya P. Dash, National Institute of Malaria Research
J. Kevin Baird, ALERTAsia FoundationFollow

Date of this Version

2009

Citation

Am. J. Trop. Med. Hyg., 81(5), 2009, pp. 758–762

Comments

Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

Abstract

An otherwise healthy 20-year-old woman in Goa, India, received antibiotics after a diagnosis of upper respiratory tract infection. One week later, vivax malaria was diagnosed at a health center, but the patient developed respiratory distress and lost consciousness. She arrived at emergency department in shock, breathless, and comatose. She died within minutes. Two independent laboratories later confirmed Plasmodium vivax by microscopy (140,000/μL) and by nested and real-time polymerase chain reaction methods. Post-mortem examination showed congestion of alveolar capillaries by heavy monocytic infiltrates, along with diffuse damage to alveolar membranes consistent with acute respiratory distress syndrome. Parasites seen in lung tissue were roughly proportionate to both peripheral hyperparasitemia and those seen in other organs without lesions. In this patient, vivax malaria caused a rapidly fatal respiratory distress.