dutch female, dob 23-12-1970 (pin 1218906) … · ust onust o lieshoute (photophoto morpholomorpho...

Don’t tell me it’s malaria again

Werkgroep klinische parasitologie “eindeloos malaria”

Lisette van Lieshout

Parasitology LEIDEN UNIVERSITY MEDICAL CENTER

Met dank aan Drs. Imro Vlasveld, Drs. Marja Konstantinovski, Prof. Dr. Leo Visser en alle laboratoriumedewerkers van het KML

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Dutch Female, DOB 23-12-1970 (PIN 1218906) • Seen at LUMC in 15th November 2016

• Diagnosed with P. falciparum in Ghana around November 1st

• Traveled 5 weeks before, West Africa

• Hospitalized for 3 days, treated (IV and orally) in Ghana,

• Back to NL, hospitalized at AMC (4-5 Nov), treated artemether/lumefantrine Feeling well during the week • Visited LUMC because 15th symptoms started again

• dd: Incomplete treatment of malaria LUMC/KML: • RDT/QBC/microscopy///PCR • (PCR: multiplex Pf, Pv, Po(2x), Pm, based on 18S)

2 PCR: Adegnika et al. (2006); Wiria et al., (2010); > 2009 on all malaria requests

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Diagnostic tests – 15 November 2016:

ICT – malaria RDT: T1 positive QBC: negative Microscopy: negative

3

Example of P. falciparum gametocytes in QBC

Quantitative Buffy Coat (QBC) test (acradine orange)

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LUMC/KML: • ICT positive (T1), QBC negative, microscopy negative Clinic: • artemether/lumefantrine t=0,8, 24,48, 72,96 KML: • PCR P.falciparum positive: Ct 37.2

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January 3rd 2017 • Again high fever, headache, feels very sick, started 30th Dec • Peaks on 30/12, 31/13, 2/1 • 4 days Algeria, 2 weeks Sudan, no prophylaxis • Malaria?

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Diagnostics

ICT – malaria RDT: negative • Antigen detection not sensitive for low P. falciparum

infections, or non-P.falciparum species QBC: positive (but species not so clear) Microscopy……..

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Centrum voor Infectieziekten

Afdeling Parasitologie

E.A.T. Brienen

Diagnostics - microscopy

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Diagnostics DDDDDDiDiDiaiaiaaagagaggggngnnnnonooooosossstststtititicicccscscsss microscopymmmmmmmmimimicicicccrcrrrororooososossscscccococoooopopopppypypyyyyyCentrum voor Infectieziekten


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fdeling Para

E.A.T. Br

UMCM


9



E.A.T. Brienen

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10

Diagnostics DDDDDDiDiDiaiaiaaagagagggngngnnnononoooosososststststtiticticicccscscss s - --- microscopymmmmmmmmimimicicicccrcrrorororooosososscscscccocooooopopopppypypyyyyyCentrum voor Infectieziekten


E.A.T. Brienen

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fdeling Para

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Lieie


11

Diagnostics DDDDDDiDiDiaiaiaaagagagggngngnnnononoooosososststststtiticticicccscscss s - --- microscopymmmmmmmmimimicicicccrcrrorororooosososscscscccococoooopopopppypypyyyyyCentrum voor Infectieziekten


E.A.T. Brienen

ntrum

fdeling Para

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LiL


12

Diagnostics DDDDDDiDiDiaiaiaaagagaggggngnnnnonooooosossstststtititiciccccscsss microscopymmmmmmmimimicicicccrcrrrororoooosssscscccococoooopopopppypypyyyyyCentrum voor Infectieziekten


E.A.T. Brienen

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fdeling Para

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13



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Microscopy: P. ovale • Hospitalized Jan 4th , very sick, a.o. photophobia (clinical symptoms of

meningitis??) • Again artemether/lumefantrine started, followed by Primaquine • P. ovale; PCR Ct – 25.9 • Improved, left hospital Jan 5th • KML:

• QBC/Microscopy: remains of parasites

• PCR: Ct 33.4 • Follow-up Jan 13th , clinically strongly improved • KML:

• QBC/Microscopy/RDT: negative

• PCR: negative

15

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To conclude

• Very sick from P. ovale (photophobia) • Atypical P. ovale morphology • PCR helpful in the diagnosis

• Rapidly negative after treatment

• Don’t trust on RDT only

16

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Next travel advise……..

17

Next travel advise……..NNNNNNeeeeexexxxxtxtttt tttttrrraraaaavvvvvveeeeelll aaaaadddddvdvvvvviiisssseeeee………………………………......

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dutch female, dob 23-12-1970 (pin 1218906) … · ust onust o lieshoute (photophoto morpholomorpho...

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