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Abstract
Recently, the number of Korean travelers and workers to malaria-endemic regions has increased, and the number of patients with imported malaria cases has increased as well. In Korea, most cases of imported malaria infections are caused by Plasmodium falciparum and P. vivax. Only one report of imported P. malariae infection has been published thus far. Here, we describe a case of imported P. malariae infection that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 53-yr-old man, who had stayed in the Republic of Guinea in tropical West Africa for about 40 days, experienced fever and headache for 3 days before admission. The results of rapid malaria test using the SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Wright-Giemsa stained peripheral blood smear revealed Plasmodium. To identify the Plasmodium species and to examine if the patient had a mixed infection, we performed nested PCR targeting the SSU rRNA gene. P. malariae single infection was confirmed by nested PCR. Sequence analysis of the SSU rRNA gene of P. malariae showed that the isolated P. malariae was P. malariae type 2. Thus, our findings suggest that when cases of imported malaria infection are suspected, infection with P. malariae as well as P. falciparum and P. vivax should be considered. For the accurate diagnosis and treatment of imported malaria cases, we should confirm infection with Plasmodium species by PCR as well as peripheral blood smear and rapid malaria antigen test.
Figures and Tables
Fig. 1
Wright-Giemsa stained peripheral blood smear (×1,000). Typical "band" form trophozoites (A, B), "basket" form trophozoites in which the chromatin is located in the center of the vacuole (C), and the schizont form (D) are observed in red blood cells. No red cell enlargement was noted.
Fig. 2
Plasmodium species-specific nested PCR. In the first PCR, 1,100 bp of the Plasmodium gene was identified. Plasmodium malariae product (144 bp) was detected in the second species-specific PCR. Three other products, P. vivax (120 bp), P. falciparum (205 bp), and P. ovale (800 bp), were also successfully detected as positive controls.
Abbreviations: P, positive control; N, negative control; Pt, Patient sample; M, DNA ladder marker.
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