Plasmodium knowlesi: Difference between revisions

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*Those who are treated with intra venous Artisunate should be monitored for delayed hemolytic anemia, with repeat hemoglobin testing at 7 and 14 days after treatment.<ref name="pmid24859359">{{cite journal |vauthors=Jauréguiberry S, Ndour PA, Roussel C, Ader F, Safeukui I, Nguyen M, Biligui S, Ciceron L, Mouri O, Kendjo E, Bricaire F, Vray M, Angoulvant A, Mayaux J, Haldar K, Mazier D, Danis M, Caumes E, Thellier M, Buffet P |title=Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins |journal=Blood |volume=124 |issue=2 |pages=167–75 |date=July 2014 |pmid=24859359 |doi=10.1182/blood-2014-02-555953 |url=}}</ref>
*Those who are treated with intra venous Artisunate should be monitored for delayed hemolytic anemia, with repeat hemoglobin testing at 7 and 14 days after treatment.<ref name="pmid24859359">{{cite journal |vauthors=Jauréguiberry S, Ndour PA, Roussel C, Ader F, Safeukui I, Nguyen M, Biligui S, Ciceron L, Mouri O, Kendjo E, Bricaire F, Vray M, Angoulvant A, Mayaux J, Haldar K, Mazier D, Danis M, Caumes E, Thellier M, Buffet P |title=Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins |journal=Blood |volume=124 |issue=2 |pages=167–75 |date=July 2014 |pmid=24859359 |doi=10.1182/blood-2014-02-555953 |url=}}</ref>
====Supportive care====
====Supportive care====
*Severe Plasmodium knowlesi infection can result in complications like multi organ failure which require intensive supportive care including inotropic and ventilatory support and hemodialysis for acute kidney injury.<ref name="pmid21762579">{{cite journal |vauthors=William T, Menon J, Rajahram G, Chan L, Ma G, Donaldson S, Khoo S, Frederick C, Jelip J, Anstey NM, Yeo TW |title=Severe Plasmodium knowlesi malaria in a tertiary care hospital, Sabah, Malaysia |journal=Emerging Infect. Dis. |volume=17 |issue=7 |pages=1248–55 |date=July 2011 |pmid=21762579 |pmc=3381373 |doi=10.3201/eid1707.101017 |url=}}</ref>
*There are no clinical guidelines available on the intravenous fluid therapy during plasmodium knowlesi infection, hence Intravenous fluids should be administered conservatively.<ref name="pmid25629462">{{cite journal |vauthors=Hanson J, Anstey NM, Bihari D, White NJ, Day NP, Dondorp AM |title=The fluid management of adults with severe malaria |journal=Crit Care |volume=18 |issue=6 |pages=642 |date=November 2014 |pmid=25629462 |pmc=4318383 |doi=10.1186/s13054-014-0642-6 |url=}}</ref>
*Broad spectrum antibiotics are commonly used in Plasmodium knowlesi infections until the blood cultures are negative.


==<i>Plasmodium knowlesi</i> genome data==
==<i>Plasmodium knowlesi</i> genome data==

Revision as of 16:43, 15 November 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]

Plasmodium knowlesi
Scientific classification
Kingdom: Protista
Phylum: Apicomplexa
Class: Aconoidasida
Order: Haemosporida
Family: Plasmodiidae
Genus: Plasmodium
Species: P. knowlesi
Binomial name
Plasmodium knowlesi

Overview

Plasmodium knowlesi is a simian parasite that cause malaria; the natural hosts are macaques.[1] Human cases of Plasmodium knowlesi malaria have been reported throughout the Southeast Asia; most cases have been reported from Malaysia, particularly the eastern Malaysian states of Sabah and Sarawak.[2] this malaria is generally acquired in forest or forest-fringe areas; those at risk include farmers, plantation workers, and individuals undertaking other activities in forested areas. Adult population is commonly affected more than children and the mortality increases as the age increases. [3]

Epidemiology

  • Reports of human P. knowlesi infections are confined to Southeast Asia,[4][5] particularly Malaysia,[6] but there are also reports on the Thai-Burmese border.[7] A fifth of the cases of malaria diagnosed in Sarawak, Malaysian Borneo are due to P. knowlesi.[6]
  • P. knowlesi infection is normally considered an infection of long-tailed (Macaca fascicularis) and pig-tailed (M. nemestrina) macaques, but humans who work at the forest fringe or enter the rainforest to work are at risk of being infected with P. knowlesi.
  • The first case of naturally acquired human infection with P. knowlesi was reported in 1965 in a United States national working in Malaysia.[8]
  • The mosquito Anopheles latens is attracted to both macaques and humans and has been shown to be the main vector transmitting P. knowlesi to humans in the Kapit Division of Sarawak, Malaysian Borneo[9]. Within the monkey population in Peninsular Malaysia, A. hackeri, is believed to be the main vector of 'P. knowlesi' : although 'A. hackeri' is capable of transmitting malaria to humans,[10] it is not normally attracted to humans and therefore cannot be an important vector for transmission.[11]

Transmission and risk factors for infection

  • Human-mosquito-human transmission has been demonstrated in the laboratory setting but has not yet been proven to occur in the natural environment.[12]
  • Cases of P. knowlesi in humans have been reported to occur in clusters, affecting individuals of all ages.
  • Transmission is predominantly zoonotic but it appears possible that human-mosquito-human transmission may occur (at least to some degree) in endemic areas.[13]
  • Risk factors for acquiring P. knowlesi infection include:[14]
  1. Male gender
  2. Age greater than 15 years
  3. Sleeping outside
  4. Proximity to monkeys in the preceding four weeks
  5. Presence of open eaves or gaps in walls
  6. Presence of long grass around dwelling
  • Protective factors against P. knowlesi infection in one study included:[14]
  1. G6PD deficiency
  2. Residual insecticide spraying of household walls
  3. Presence of sparse forest or rice paddies around the house
  4. Use of bed nets was not protective
  • children Less than 15 years accounted for only 10 % of all P. knowlesi cases in Sabah, Malaysia, between 2010 and 2014.[15]
  • Transfusion-transmitted P. knowlesi malaria has been reported in Malaysia.[16]

Clinical Features

  • The clinical features of Plasmodium knowlesi infection ranges from asymptomatic infection to severe disease.
  • Most patients have uncomplicated disease; severe disease occurs in less than 10 % of symptomatic adults.[3]
  • The incubation period of P. knowlesi infection is in the range of 3 to 27 days.[17]
  • Parasites normally appear in the blood several days after the initial temperature rise.

Nonpregnant adults

Uncomplicated infection

  • Uncomplicated P. knowlesi malaria is defined as clinical illness with parasitemia <15,000/uL and no features of severe malaria.
  • Clinical manifestations of P. knowlesi infection in adults include:
  • Symptoms
  1. Fever and Chills
  2. Headache
  3. Myalgia
  4. Nausea and Vomitting
  5. Abdominal pain
  6. Diarrhea
  7. Cough
  • Signs
  1. fever of greater than 101F
  2. Tachycardia
  3. Tachypnea
  4. Splenomegaly
  5. Hepatomegaly
  • Neurologic manifestations are rare in P. knowlesi infection.[3]
  • Retinopathy has been described in association with P. knowlesi infection; However, the characteristic retinal whitening seen in severe falciparum malaria has not been observed in knowlesi malaria.[18]

Severe infection

  • Severe P. knowlesi infection occurs when the parasitemia level is >15,000/microL.[3]
  • The likelihood of hyperparasitemia correlates with age, with age ≥45 years being the best predictor of hyperparasitemia. Older adults have higher parasitemias and thus are at greater risk of severe disease.[19]
  • Clinical manifestations of severe disease include:[20]
  1. Jaundice
  2. Acute kidney injury
  3. Respiratory distress
  4. Shock

Children

  • Plasmodium kowlesi infection is uncommon in chlidern.
  • Clinical manifestations are similar to those in adults, including rigors, headache, abdominal pain, cough, vomiting, arthralgia, and myalgia. [3]
  • Thrombocytopenia and mild to moderate anemia are also common in childern having P knowlesi infection.[3]

Pregnant women

  • Plasmodium knowlesi infection is rare during pregnancy. only five cases have been reported so far.[21]

Diagnosis

  • P. knowlesi infections is diagnosed by examining thick and thin blood films in the same way as other malarias.
  • The appearance of P. knowlesi is similar to that of P. malariae and is unlikely to be correctly diagnosed except by using molecular detection assays [6]
  • Reporting of P. knowlesi as the more benign P. malariae has been associated with failure to recognize severe malaria and consequent delayed initiation of parenteral therapy, with fatal outcomes.
  • P. knowlesi malaria should be suspected in the setting of febrile illness after exposure to regions where P. knowlesi malaria is endemic.
  • The approach to diagnosis of P. knowlesi malaria consists of microscopy to guide immediate clinical management, followed by confirmatory testing with PCR.
  • PCR is the gold standard diagnostic tool with high sensitivity and specificity.[22]
  • Microscopy is a sensitive tool for the detection of level of parasitemia and to know the life cycle stages of Plasmodium knowlesi.
  • Microscopy can not be used for the differentiation of different species of Plasmodium , as the blood stages of P. knowlesi resemble P. malariae and the ring stages resemble P. falciparum.[23]
  • Patients in endemic regions of P. knowlesi malaria with microscopy findings resembling P. malariae should be treated for P. knowlesi infection.
  • Rapid diagnostic tests (RDTs) are useful for excluding P. falciparum infection but have low sensitivity for detection of P. knowlesi infection, especially at the low parasite densities commonly causing clinical disease.[24]

Treatment

  • All adults with known or suspected P. knowlesi infection should be admitted to hospital for management, because of the significant risk of severe disease at relatively low parasitemia and the risk of developing complications after commencement of treatment.[25]

Adults

Uncomplicated Infection

  • Treatment of uncomplicated Plasmodium knowlesi infection consists of oral Artemisinin Combination Therapy (ACT) regimen.
  • Those patients who can not tolerate oral therapy are offered parenteral therapy.
  • Artemisinin Combination Therapy (ACT) regimen is superior to chloroquine for treatment of drug-resistant P. falciparum and P. vivax malaria found in regions where co-infection can occur.[26]
  • use of chloroquine for the treatment of microscopy-diagnosed Plasmodium knowlesi infection may result in inadvertent administration of chloroquine for misdiagnosed P. falciparum or P. vivax infection.[27]
  • Combination of Artemether-lumefantrine is the preferred ACT for treatment of uncomplicated P. knowlesi malaria, because of its excellent efficacy, ability to be tolerated and its wide availability.[21]
  • Artesunate-Mefloquine and Dihydroartemisinin-piperaquine have also been used as ACT for the treatment of uncomplicated plasmodium knowlesi infection.[28]
  • Chloroquine can also be used in the treatment of uncomplicated Plasmodium knowlesi but it is associated with slower parasite clearance times and a higher frequency of anemia than ACTs.[29]
    • Chloroquine total dose is 25 mg base/kg which is administered as 10 mg base/kg orally on first day, followed by 10 mg base/kg orally on second day, and 5 mg base/kg on third day.
  • In returned travelers, Atovaquone-proguanil has been used for the treatment of uncomplicated Plasmodium knowlesi infection.
    • In Adult atovaquone-proguanil dose is four adult tabs (250 mg atovaquone/100 mg proguanil) orally once daily for three days.

Severe infection

  • Treatment of severe malaria infection regardless of the specie is parenteral Artisunate.
  • Intravenous artesunate should be administered for a minimum of three doses followed by a three day course of oral ACT only if oral intake can be tolerated.
  • If intravenous Artisunate is not available then intravenous quinine is an acceptable alternative therapy.
  • Those who are treated with intra venous Artisunate should be monitored for delayed hemolytic anemia, with repeat hemoglobin testing at 7 and 14 days after treatment.[30]

Supportive care

  • Severe Plasmodium knowlesi infection can result in complications like multi organ failure which require intensive supportive care including inotropic and ventilatory support and hemodialysis for acute kidney injury.[21]
  • There are no clinical guidelines available on the intravenous fluid therapy during plasmodium knowlesi infection, hence Intravenous fluids should be administered conservatively.[31]
  • Broad spectrum antibiotics are commonly used in Plasmodium knowlesi infections until the blood cultures are negative.

Plasmodium knowlesi genome data

References

  1. Napier LE, Campbell H (May 1932). "Observations on a Plasmodium Infection Which Causes Hæmoglobinuria in Certain Species of Monkey". Ind Med Gaz. 67 (5): 246–249. PMC 5231784. PMID 29011028. Vancouver style error: initials (help)
  2. Shearer FM, Huang Z, Weiss DJ, Wiebe A, Gibson HS, Battle KE, Pigott DM, Brady OJ, Putaporntip C, Jongwutiwes S, Lau YL, Manske M, Amato R, Elyazar IR, Vythilingam I, Bhatt S, Gething PW, Singh B, Golding N, Hay SI, Moyes CL (August 2016). "Estimating Geographical Variation in the Risk of Zoonotic Plasmodium knowlesi Infection in Countries Eliminating Malaria". PLoS Negl Trop Dis. 10 (8): e0004915. doi:10.1371/journal.pntd.0004915. PMC 4975412. PMID 27494405.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Grigg MJ, William T, Barber BE, Rajahram GS, Menon J, Schimann E, Piera K, Wilkes CS, Patel K, Chandna A, Drakeley CJ, Yeo TW, Anstey NM (July 2018). "Age-Related Clinical Spectrum of Plasmodium knowlesi Malaria and Predictors of Severity". Clin. Infect. Dis. 67 (3): 350–359. doi:10.1093/cid/ciy065. PMC 6051457. PMID 29873683.
  4. Chin W, Contacos PG, Coatney RG, Kimbal HR. (1965). "A naturally acquired quotidian-type malaria in man transferable to monkeys". Science. 149: 865. PMID 14332847.
  5. Yap FL, Cadigan FC, Coatney GR. (1971). "A presumptive case of naturally occurring Plasmodium knowlesi malaria in man in Malaysia". Trans R Soc Trop Med Hyg. 65 (6): 839&ndash, 40. PMID 5003320.
  6. 6.0 6.1 6.2 Singh B, Lee KS, Matusop A, Radhakrishnan A, Shamsul SSG, Cox-Singh J, Thomas A, Conway DJ (2004). "A large focus of naturally acquired Plasmodium knowlesi infections in human beings". Lancet. 363: 1017&ndash, 24. doi:10.1016/S0140-6736(04)15836-4.
  7. Jongwutiwes S, Putaporntip C, Iwasaki T, Sata T, Kanbara H. (2004). "Naturally acquired Plasmodium knowlesi malaria in human, Thailand". Emerg Infect Dis. 10 (12): 2211&ndash, 3. PMID 15663864.
  8. CHIN W, CONTACOS PG, COATNEY GR, KIMBALL HR (August 1965). "A NATURALLY ACQUITED QUOTIDIAN-TYPE MALARIA IN MAN TRANSFERABLE TO MONKEYS". Science. 149 (3686): 865. PMID 14332847.
  9. Vythilingam I, Tan CH, Asmad M, Chan ST, Lee KS, Singh B. (2006). "Natural transmission of Plasmodium knowlesi to humans by Anopheles latens in Sarawak, Malaysia". Trans R Soc Trop Med Hyg. 100: 1087&ndash, 88. doi:10.1016/j.trstmh.2006.02.006.
  10. Wharton RH, Eyles DE. (1961). "Anopheles hackeri, a vector of Plasmodium knowlesi in Malaya". Science. 134: 279&ndash, 80.
  11. Reid JA, Weitz B. (1961). "Anopheline mosquitoes as vectors of animal malaria in Malaya". Ann Trop Med Parasitol. 55: 180&ndash, 6.
  12. Chin W, Contacos PG, Collins WE, Jeter MH, Alpert E (May 1968). "Experimental mosquito-transmission of Plasmodium knowlesi to man and monkey". Am. J. Trop. Med. Hyg. 17 (3): 355–8. PMID 4385130.
  13. Barber BE, William T, Dhararaj P, Anderios F, Grigg MJ, Yeo TW, Anstey NM (December 2012). "Epidemiology of Plasmodium knowlesi malaria in north-east Sabah, Malaysia: family clusters and wide age distribution". Malar. J. 11: 401. doi:10.1186/1475-2875-11-401. PMC 3528466. PMID 23216947.
  14. 14.0 14.1 Grigg MJ, Cox J, William T, Jelip J, Fornace KM, Brock PM, von Seidlein L, Barber BE, Anstey NM, Yeo TW, Drakeley CJ (June 2017). "Individual-level factors associated with the risk of acquiring human Plasmodium knowlesi malaria in Malaysia: a case-control study". Lancet Planet Health. 1 (3): e97–e104. doi:10.1016/S2542-5196(17)30031-1. PMC 5531251. PMID 28758162.
  15. Rajahram GS, Barber BE, William T, Grigg MJ, Menon J, Yeo TW, Anstey NM (January 2016). "Falling Plasmodium knowlesi Malaria Death Rate among Adults despite Rising Incidence, Sabah, Malaysia, 2010-2014". Emerging Infect. Dis. 22 (1): 41–8. doi:10.3201/eid2201.151305. PMC 4696710. PMID 26690736.
  16. Bird EM, Parameswaran U, William T, Khoo TM, Grigg MJ, Aziz A, Marfurt J, Yeo TW, Auburn S, Anstey NM, Barber BE (July 2016). "Transfusion-transmitted severe Plasmodium knowlesi malaria in a splenectomized patient with beta-thalassaemia major in Sabah, Malaysia: a case report". Malar. J. 15 (1): 357. doi:10.1186/s12936-016-1398-z. PMC 4942937. PMID 27405869.
  17. van Rooyen CE, Pile GR (October 1935). "OBSERVATIONS ON INFECTION BY PLASMODIUM KNOWLESI (APE MALARIA) IN THE TREATMENT OF GENERAL PARALYSIS OF THE INSANE". Br Med J. 2 (3901): 662–6. PMC 2461244. PMID 20779410.
  18. Govindasamy G, Barber BE, Ghani SA, William T, Grigg MJ, Borooah S, Dhillon B, Dondorp AM, Yeo TW, Anstey NM, Maude RJ (May 2016). "Retinal Changes in Uncomplicated and Severe Plasmodium knowlesi Malaria". J. Infect. Dis. 213 (9): 1476–82. doi:10.1093/infdis/jiv746. PMID 26671886.
  19. Barber BE, Grigg MJ, William T, Piera KA, Boyle MJ, Yeo TW, Anstey NM (June 2017). "Effects of Aging on Parasite Biomass, Inflammation, Endothelial Activation, Microvascular Dysfunction and Disease Severity in Plasmodium knowlesi and Plasmodium falciparum Malaria". J. Infect. Dis. 215 (12): 1908–1917. doi:10.1093/infdis/jix193. PMID 28863470.
  20. Singh B, Daneshvar C (April 2013). "Human infections and detection of Plasmodium knowlesi". Clin. Microbiol. Rev. 26 (2): 165–84. doi:10.1128/CMR.00079-12. PMC 3623376. PMID 23554413.
  21. 21.0 21.1 21.2 William T, Menon J, Rajahram G, Chan L, Ma G, Donaldson S, Khoo S, Frederick C, Jelip J, Anstey NM, Yeo TW (July 2011). "Severe Plasmodium knowlesi malaria in a tertiary care hospital, Sabah, Malaysia". Emerging Infect. Dis. 17 (7): 1248–55. doi:10.3201/eid1707.101017. PMC 3381373. PMID 21762579.
  22. Imwong M, Tanomsing N, Pukrittayakamee S, Day NP, White NJ, Snounou G (December 2009). "Spurious amplification of a Plasmodium vivax small-subunit RNA gene by use of primers currently used to detect P. knowlesi". J. Clin. Microbiol. 47 (12): 4173–5. doi:10.1128/JCM.00811-09. PMC 2786678. PMID 19812279.
  23. William T, Jelip J, Menon J, Anderios F, Mohammad R, Awang Mohammad TA, Grigg MJ, Yeo TW, Anstey NM, Barber BE (October 2014). "Changing epidemiology of malaria in Sabah, Malaysia: increasing incidence of Plasmodium knowlesi". Malar. J. 13: 390. doi:10.1186/1475-2875-13-390. PMC 4195888. PMID 25272973.
  24. Barber BE, William T, Grigg MJ, Piera K, Yeo TW, Anstey NM (April 2013). "Evaluation of the sensitivity of a pLDH-based and an aldolase-based rapid diagnostic test for diagnosis of uncomplicated and severe malaria caused by PCR-confirmed Plasmodium knowlesi, Plasmodium falciparum, and Plasmodium vivax". J. Clin. Microbiol. 51 (4): 1118–23. doi:10.1128/JCM.03285-12. PMC 3666806. PMID 23345297.
  25. Daneshvar C, Davis TM, Cox-Singh J, Rafa'ee MZ, Zakaria SK, Divis PC, Singh B (September 2009). "Clinical and laboratory features of human Plasmodium knowlesi infection". Clin. Infect. Dis. 49 (6): 852–60. doi:10.1086/605439. PMC 2843824. PMID 19635025.
  26. Grigg MJ, William T, Menon J, Barber BE, Wilkes CS, Rajahram GS, Edstein MD, Auburn S, Price RN, Yeo TW, Anstey NM (June 2016). "Efficacy of Artesunate-mefloquine for Chloroquine-resistant Plasmodium vivax Malaria in Malaysia: An Open-label, Randomized, Controlled Trial". Clin. Infect. Dis. 62 (11): 1403–1411. doi:10.1093/cid/ciw121. PMC 4872287. PMID 27107287.
  27. Lubis I, Wijaya H, Lubis M, Lubis CP, Divis P, Beshir KB, Sutherland CJ (April 2017). "Contribution of Plasmodium knowlesi to Multispecies Human Malaria Infections in North Sumatera, Indonesia". J. Infect. Dis. 215 (7): 1148–1155. doi:10.1093/infdis/jix091. PMC 5426374. PMID 28201638. Vancouver style error: initials (help)
  28. Grigg MJ, William T, Menon J, Dhanaraj P, Barber BE, Wilkes CS, von Seidlein L, Rajahram GS, Pasay C, McCarthy JS, Price RN, Anstey NM, Yeo TW (February 2016). "Artesunate-mefloquine versus chloroquine for treatment of uncomplicated Plasmodium knowlesi malaria in Malaysia (ACT KNOW): an open-label, randomised controlled trial". Lancet Infect Dis. 16 (2): 180–188. doi:10.1016/S1473-3099(15)00415-6. PMC 4753673. PMID 26603174.
  29. Singh B, Kim Sung L, Matusop A, Radhakrishnan A, Shamsul SS, Cox-Singh J, Thomas A, Conway DJ (March 2004). "A large focus of naturally acquired Plasmodium knowlesi infections in human beings". Lancet. 363 (9414): 1017–24. doi:10.1016/S0140-6736(04)15836-4. PMID 15051281.
  30. Jauréguiberry S, Ndour PA, Roussel C, Ader F, Safeukui I, Nguyen M, Biligui S, Ciceron L, Mouri O, Kendjo E, Bricaire F, Vray M, Angoulvant A, Mayaux J, Haldar K, Mazier D, Danis M, Caumes E, Thellier M, Buffet P (July 2014). "Postartesunate delayed hemolysis is a predictable event related to the lifesaving effect of artemisinins". Blood. 124 (2): 167–75. doi:10.1182/blood-2014-02-555953. PMID 24859359.
  31. Hanson J, Anstey NM, Bihari D, White NJ, Day NP, Dondorp AM (November 2014). "The fluid management of adults with severe malaria". Crit Care. 18 (6): 642. doi:10.1186/s13054-014-0642-6. PMC 4318383. PMID 25629462.

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