Case Report: Plasmodium knowlesi Infection with Rhabdomyolysis in a Japanese Traveler to Palawan, the Philippines

Abstract

Skeletal muscle is known to be damaged by falciparum malaria via sequestration of infected erythrocytes. We present a case of rhabdomyolysis caused by infection. The patient had fever, myalgia, and muscle weakness 5 days after returning to Japan from Palawan, the Philippines. Blood test revealed thrombocytopenia and an elevated creatine kinase level. Although rhabdomyolysis resolved with fluid therapy, fever of 24-hour cycle continued and thrombocytopenia intensified. On day 7 of illness, Giemsa-stained thin blood smear revealed malaria parasites, with a parasite count of 2,380/μL, which were morphologically indistinguishable between and . Rapid diagnostic test showed a negative result. The pathogen was later confirmed to be by nested polymerase chain reaction (PCR). The patient was successfully treated with artemether/lumefantrine. This case suggests that knowlesi malaria might be able to cause skeletal muscle damage.

Plasmodium knowlesi and other malaria parasites in long-tailed macaques from the Philippines

“…In Malaysia, where the local population is infected with P. knowlesi , P. falciparum and P. vivax , infections with P. knowlesi have not only been misdiagnosed as P. malariae or P. falciparum but also as P. vivax by microscopy [4, 34, 35]. Although there have been no local human knowlesi malaria cases reported in Palawan island since Luchavez and co-workers reported the five cases in 2008 [20] and the travelers from Taiwan and USA who acquired knowlesi malaria the following year, there was a recent case report of a Japanese man who got infected with P. knowlesi during his 3 month stay at a forest resort Palawan in 2018 [22]. He was diagnosed 5 days upon his return to Japan, where a blood film revealed parasites resembling P. malariae or P. knowlesi , and a diagnosis of P. knowlesi was made following analysis by nested PCR assays.…”

The skeletal muscles of mice infected with Plasmodium berghei and Plasmodium chabaudi reveal a crosstalk between lipid mediators and gene expression

“…abnormal function and damage in the hosts. The malaria pathogens have been related to cause detrimental effects on skeletal muscles of animals and humans [3][4][5][6][7][8][9]. In addition of affecting skeletal muscles, severe malaria may cause damage on cardiac muscles [10][11][12].…”

Malarial Related Myopathies: A Rhabdomyolysis Story

“…Myalgia is a subjective and at the same time also objective muscular complaint, and it is not always prominent [1]. In severe form of malaria, although very rare, a condition of myalgia related rhabdomyolysis with myoglobinuria and skeletal muscle necrosis can occur; sometime it precede renal failure secondary to acute tubular necrosis, a very fatal complication of untreated malaria, found on both vivax or falciparum malaria [9][10][11]. It must be kept in mind once again, it is not species specific [9][10][11].…”

“…In severe form of malaria, although very rare, a condition of myalgia related rhabdomyolysis with myoglobinuria and skeletal muscle necrosis can occur; sometime it precede renal failure secondary to acute tubular necrosis, a very fatal complication of untreated malaria, found on both vivax or falciparum malaria [9][10][11]. It must be kept in mind once again, it is not species specific [9][10][11]. It can happened whenever the patient's condition get worse, even when the patient already in the intensive care unit [12,13].…”