Emerging Infectious Diseases (Jul 2011)

Severe Plasmodium knowlesi Malaria in a Tertiary Care Hospital, Sabah, Malaysia

  • Timothy William,
  • Jayaram Menon,
  • Giri S. Rajahram,
  • Leslie Chan,
  • Gordon Ma,
  • Samantha Donaldson,
  • Serena Khoo,
  • Charlie Fredrick,
  • Jenarun Jelip,
  • Nicholas M. Anstey,
  • Tsin Wen Yeo

DOI
https://doi.org/10.3201/eid1707.101017
Journal volume & issue
Vol. 17, no. 7
pp. 1248 – 1255

Abstract

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The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007–November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1–2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.

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