Cardiac complication after experimental human malaria infection: a case report

Abstract

A 20 year-old healthy female volunteer participated in a clinical Phase I and IIa safety and efficacy trial with candidate malaria vaccine PfLSA-3-rec adjuvanted with aluminium hydroxide. Eleven weeks after the third and last immunization she was experimentally infected by bites of Plasmodium falciparum-infected mosquitoes. When the thick blood smear became positive, at day 11, she was treated with artemether/lumefantrine according to protocol. On day 16 post-infection i.e. two days after completion of treatment, she woke up with retrosternal chest pain. She was diagnosed as acute coronary syndrome and treated accordingly. She recovered quickly and her follow-up was uneventful. Whether the event was related to the study procedures such as the preceding vaccinations, malaria infection or antimalarial drugs remains elusive. However, the relation in time with the experimental malaria infection and apparent absence of an underlying condition makes the infection the most probable trigger. This is in striking contrast, however, with the millions of malaria cases each year and the fact that such complication has never been reported in the literature. The rare occurrence of cardiac events with any of the preceding study procedures may even support a coincidental finding.Apart from acute coronary syndrome, myocarditis can be considered as a final diagnosis, but the true nature and patho-physiological explanation of the event remain unclear.

Comparison of Clinical and Parasitological Data from Controlled Human Malaria Infection Trials

“…One serious cardiac adverse event was reported; the true nature and patho-physiological explanation of that event remains unclear [21]. Severe adverse events (grade 3) related to clinical malaria occur in up to half of the volunteers and persist for several days.…”

Malaria and the heart

“…However, the epidemiology and clinical course of vivax malaria appears to be changing with cases of vivax malaria being complicated with ARDS, acute kidney injury, anaemia and cerebral malaria 3. Considering the high incidence of malaria in sub-Saharan Africa, India and South-East Asia, very few cardiac complications have been reported 4 5. Malaria may be a risk factor for acute myocardial infarction (MI).…”

Controlled Human Malaria Infections by Intradermal Injection of Cryopreserved Plasmodium falciparum Sporozoites

“…Hematological and biochemical parameters were monitored daily. Because of a previous cardiac-related serious adverse event (SAE) following CHMI with Pf infection,39 markers of cardiac damage and coagulation were assessed. Troponin, lactate dehydrogenase (LDH), platelets, and D-dimer were assessed daily during the period when blood stage parasitemia was expected, and for 3 days after initiating curative treatment with atovaquone/proguanil.…”