Plasmodium in the bone marrow: case series from a hospital in Pakistan, 2007–2015

Abstract

Background Malaria is a life-threatening, multisystem disease caused by the plasmodial parasite with a global incidence of approximately 229 million annually. The parasites are known to have unique and crucial interactions with various body tissues during its life cycle, notably the liver, spleen, and recent work has shown the bone marrow to be a reservoir of infection. Methods This study is a case series of patients in whom examination of bone marrow revealed malarial parasites. A retrospective record review of 35 parasite-positive bone marrow specimens examined at Aga Khan University Hospital (AKUH), Karachi, Pakistan, over the years 2007 to 2015 was conducted. Bone marrow aspirates were collected as per International Council for Standardization in Haematology (ICSH) guidelines. Results The median age of patients was 22 years (range 1–75), and 60 % (n = 21) were male. 22 patients had evidence of Plasmodium falciparum, 12 had evidence of Plasmodium vivax and 1 patient had a mixed infection. Gametocytes and trophozoites were the most common stages identified on both peripheral blood and bone marrow examinations. Indications for bone marrow examination included fever of unknown origin and the workup of cytopenias and malignancies. Conclusions The incidental finding of Plasmodium in samples of bone marrow suggests the reticuloendothelial system may be regularly harbour these parasites, be the infection acute or chronic in character.

Examination of Plasmodium parasites in bone marrow puncture fluid for the diagnosis of imported-malaria in patients from the Yunnan Province, China

“…In the current study, neither Plasmodium nor pLDH antigens were detected in peripheral blood of the two cases of Plasmodium vivax infection, yet late-stage large trophozoite and stage-IV gametophytes with intact cell structure were detected in bone marrow aspirate [5,20], and the erythrocytes infected by Plasmodium vivax had not still exhibited the Schuffner' dots, which consistenting with the previous features observated in peripheral blood(Additional le 4). Such nding provides a solid etiological basis for the diagnosis of Plasmodium vivax by using bone marrow puncture.…”

“…examination of bone marrow uid for Plasmodium infection is mostly applied as supplementary for the clinical diagnosis of other diseases that requires the testing of the bone marrow [4][5][6]. Essentially, bone marrow puncture could play a more vital role in the diagnosis of Plasmodium vivax infection than peripheral blood examination [10][11], by virtue of the production of a lower density and de cient symptom of parasitemia.…”

“…Essentially, bone marrow puncture could play a more vital role in the diagnosis of Plasmodium vivax infection than peripheral blood examination [10][11], by virtue of the production of a lower density and de cient symptom of parasitemia. In comparison with bone marrow puncture, peripheral blood screening for Plasmodium infection has been reported to cause a false-negative rate of 11.4% (4/35) in Pakistan [5].…”

“…Bone marrow infection may be a common symptom for acute severe malaria and chronic malaria [13,5]. The persistent parasitemia after malarial infection would in turn trigger myelosuppression [15] and leading to heterogeneity hematological abnormalities [29].…”

“…This procedure compensated for the low accuracy in the con rmation of malaria infection by using blood lm examination. Gandapur et al [4] detected Plasmodium infection in the bone marrow uid of 1.3% (26/1966) of Gambians and 0.13% (35/25867) of Pakistani [5]. Aguilar et al [6] detected malaria parasites in both bone marrow uid and peripheral blood of 174 Mozambican children, reporting that the positive rate of Plasmodium in bone marrow aspirate was signi cantly higher than that in peripheral blood (14.4% v.s.…”