Imported Plasmodium vivax malaria complicated by reversible myocarditis

Khan, Fahmi Yousef

doi:10.4103/jfcm.jfcm_78_19

Cited by 6 publications

References 7 publications

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Chloroquine for SARS-CoV-2: Implications of Its Unique Pharmacokinetic and Safety Properties

et al. 2020

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Since in vitro studies and a preliminary clinical report suggested the efficacy of chloroquine for COVID-19-associated pneumonia, there is increasing interest in this old antimalarial drug. In this article, we discuss the pharmacokinetics and safety of chloroquine that should be considered in light of use in SARS-CoV-2 infections. Chloroquine is well absorbed and distributes extensively resulting in a large volume of distribution with an apparent and terminal half-life of 1.6 days and 2 weeks, respectively. Chloroquine is metabolized by cytochrome P450 and renal clearance is responsible for one third of total clearance. The lack of reliable information on target concentrations or doses for COVID-19 implies that for both adults and children, doses that proved effective and safe in malaria should be considered, such as 'loading doses' in adults (30 mg/kg over 48 h) and children (70 mg/kg over 5 days), which reported good tolerability. Here, plasma concentrations were < 2.5 μmol/L, which is associated with (minor) toxicity. While the influence of renal dysfunction, critical illness, or obesity seems small, in critically ill patients, reduced absorption may be anticipated. Clinical experience has shown that chloroquine has a narrow safety margin, as three times the adult therapeutic dosage for malaria can be lethal when given as a single dose. Although infrequent, poisoning in children is extremely dangerous where one to two tablets can potentially be fatal. In conclusion, the pharmacokinetic and safety properties of chloroquine suggest that chloroquine can be used safely for an acute virus infection, under corrected QT monitoring, but also that the safety margin is small, particularly in children.

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Chloroquine for SARS-CoV-2: Implications of Its Unique Pharmacokinetic and Safety Properties

et al. 2020

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Malaria and encephalopathy in a heart transplant recipient: A case report in the context of multiorgan donation

Vernaza

Pinilla-Monsalve

Cañas

et al. 2021

Transplant Infectious Dis

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Introduction:Malaria is an endemic infection in tropical circles. It can be transmitted from mosquitoes bite, but exceptional cases have been attributed to multiorgan transplantation.Case report: This is a 34-year-old woman who received a heart transplant for finalstage dilated cardiomyopathy. Over the hospitalization, she developed fever, cephalalgia, and tonic-clonic seizures with MRI findings compatible with posterior reversible encephalopathy. A thick blood smear revealed hemoparasitic forms of Plasmodium vivax. Afterward, malaria was also diagnosed in recipients of one kidney and liver of the same organ donor. First-line treatment with artesunate was prescribed for 3 days and chloroquine with primaquine thereafter for 14 days. The patient was discharged and returned to the emergency department 5 days later, complaining of gastrointestinal symptoms and developed multiorgan failure that led to death. Conclusion:We report a case of malaria transmission through heart transplantation.Despite adequate and supervised treatment, it can be related to a fatal outcome.Malaria screening in organ donors should be considered in regions where endemicity can lead to rare cases of transmission by transplantation.

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Case of myocarditis secondary to severePlasmodium falciparuminfection

2022

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Malaria remains one of the most prevalent infectious diseases globally. Despite targets set out by the WHO in 2015, there has been a rise in the number of cases since 2019 as an indirect effect of the COVID-19 pandemic.Cardiac complications are very rarely witnessed with severe malaria. Of the cardiac sequelae, myocarditis is one of the most frequently observed with a handful of case reports in the literature. We report a case of a man in his 50s who developed myocarditis while being managed for severePlasmodium falciparummalaria in an intensive care unit in the UK and review the literature relevant to this case. This is the second reported case of this condition in the UK.

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Imported Plasmodium vivax malaria complicated by reversible myocarditis

Cited by 6 publications

References 7 publications

Chloroquine for SARS-CoV-2: Implications of Its Unique Pharmacokinetic and Safety Properties

Chloroquine for SARS-CoV-2: Implications of Its Unique Pharmacokinetic and Safety Properties

Malaria and encephalopathy in a heart transplant recipient: A case report in the context of multiorgan donation

Case of myocarditis secondary to severePlasmodium falciparuminfection

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