Co-incidental Plasmodium Knowlesi and Mucormycosis infections presenting with acute kidney injury and lower gastrointestinal bleeding

Abstract

BackgroundPlasmodium knowlesi is frequently reported in Southeast Asian countries and is now widely regarded as the fifth malarial parasite. Mucormycosis is a rare fungal infection that can occur in patients with a weakened immune system.Case Report:We report a case of acute kidney injury secondary to Plasmodium knowlesi malaria infection and mucormycosis fungal infection. In addition, the patient also had lower gastrointestinal bleeding from invasive gastrointestinal mucormycosis. P. knowlesi infection was diagnosed by blood film and mucormycosis was diagnosed by histopathological examination of biopsy specimen of the colon. The patient recovered with antimalarial treatment (Quinine), antifungal treatment (Lipophilic Amphotericin), and supportive hemodialysis treatment.Conclusions:We hypothesize that P. knowlesi malarial infection can lower the immunologic threshold and predisposes vulnerable individuals to rare disseminated fungal infections. To the best of our knowledge, this is the first P. Knowlesi malaria-associated invasive fungal infection reported in the literature.

Effect of different habitat types on abundance and biting times of Anopheles balabacensis Baisas (Diptera: Culicidae) in Kudat district of Sabah, Malaysia

“…Similarly, many other countries in Southeast Asia have also reported cases, e.g. Kalimantan, Indonesia [25, 26]; Sumatra, Indonesia [27]; Brunei [28]; Thailand [29, 30]; Vietnam [31, 32]; Singapore [16, 33]; Phillippines [34]; Myanmar [35]; Cambodia [36]; and recently Laos [37].…”

A Cecal Mucormycosis Mass Mimicking Colon Cancer in a Patient with Renal Transplant: A Case Report and Literature Review

“…The most common presenting symptoms of gastrointestinal mucormycosis are abdominal pain (68%), gastrointestinal bleeding (48%), and fever with change in bowel habit (<20%) [ 7 ]. Gastrointestinal mucormycosis is rare and accounts for 4–7% of all mucormycoses, and there is colon involvement in 32% of patients [ 2 ]. In a review of 87 patients with gastrointestinal mucormycosis, the most commonly affected organs were the stomach (57.5%), colon (32.2%), small bowel (10.4%), and esophagus (7%) [ 8 ].…”

“…Gastrointestinal mucormycosis is rare and accounts for 4–7% of all mucormycoses, and the colon is involved in 32% of all cases of gastrointestinal mucormycosis [ 2 ]. In patients who received a solid-organ transplant, the colon is only involved in 7.6% of gastrointestinal mucormycosis [ 3 ].…”

Defining the Geographical Range of the Plasmodium knowlesi Reservoir

“…In two studies we could not distinguish between adjacent administrative divisions so these areas were combined (at the Myanmar/China border and at the Myanmar/Thailand border). Two reports of human cases from Brunei did not meet the inclusion criteria because one used microscopy only for diagnosis [8] and the other did not publish their diagnostic methods [7] .…”

“…It is known to cause severe and fatal disease in humans [1] – [4] and is the most common cause of clinical malaria in high transmission regions of Malaysia [5] , [6] where it is three times more likely to cause severe malaria than P. falciparum [4] . However, costly P. knowlesi -specific molecular diagnostic techniques are only used to confirm diagnosis by microscopy in one area, Malaysian Borneo, whereas human cases have been reported from Brunei [7] , [8] , Cambodia [9] , Indonesia [10] , [11] , Myanmar [12] – [14] , the Andaman and Nicobar Islands of India [15] , the Philippines [16] , [17] , Singapore [18] – [20] , Thailand [12] , [21] – [24] and Viet Nam [25] , [26] as well as most parts of Malaysia [2] – [4] , [6] , [27] – [42] . The geographical limits of this disease and the spatial variation in disease risk within these limits are simply unknown.…”