Changes in bone marrow in malaria-a prospective study of 47 cases

Abstract

Background: Bone marrow aspiration done in cases of repeated fever, fever of unknown origin, pancytopenia to detect Malaria parasite in bone marrow. The study was undertaken to evaluate the role of bone marrow aspiration in establishing the etiology of Plasmodium vivax in cases of pancytopenia or thrombocytopenia in recurrent fever or fever of unknown origin.Methods: Patients of different age groups presenting with recurrent fever or fever of unknown origin with pancytopenia or thrombocytopenia from Jan 2015 to Oct 2017. Out of the 108 bone marrow aspirations abiding the above criteria 47 showed presence of Plasmodium vivax trophozoites in bone marrow.Results: The age of patients varied from 8 months to 65 years. 47 cases showed presence of Plasmodium vivax trophozoites, mainly with hyperplastic marrow showing normoblastic and megaloblastic hyperplasia, presence of hemophagocytosis in 6 cases and also 2 cases showing increase in plasma cells.Conclusions: Bone marrow aspiration studies are of vital importance in diagnosing malarial infection in endemic areas as being one of the cause of pancytopenia or thrombocytopenia.

African Plasmodium vivax malaria improbably rare or benign

“…The donor had traveled to Papua New Guinea and acquired P. vivax malaria but had been twice treated and remained healthy in the 11 months before marrow donation. In a series of 108 bone marrow aspirates from patients in India with fever of unknown cause and having anemia, thrombocytopenia, or pancytopenia, 47 showed trophozoites of P. vivax [72]. Jandial et al [73] similarly screened 76 patients, finding 4 infected by P. vivax.…”

“…Lampah et al [85] found both anemia and thrombocytopenia as risk factors for death with hospitalization due to acute malaria (any species) in eastern Indonesia; those had adjusted odds ratios of 4.9 and 2.8, respectively, whereas in patients experiencing both, that ratio was 13.8 (P < .001). The marrow may show normoblastic and megablastic hyperplasia, dyserythropoiesis, inefficient erythropoiesis, and evidence of secondary hemophagocytic lymphohistiocytosis in some cases [71][72][73][74][75][76][83][84][85][86].…”

Parasitaemia and fever in uncomplicated Plasmodium vivax malaria: a systematic review and individual patient data meta-analysis

“…As peripheral parasitaemia decreases the pre-test probability of concurrent malarial fever reduces, thus, in patients with lower parasitaemia, alternative causes of febrile illness should be considered, such as sepsis requiring antibiotic treatment. It is also possible that symptomatic malaria may occasionally occur in nonimmune patients who have a rising (but as yet undetectable) parasitaemia (9).…”