Severe Plasmodium ovale malaria complicated by acute respiratory distress syndrome in a young Caucasian man
© The Author(s) 2018
Received: 12 January 2018
Accepted: 23 March 2018
Published: 2 April 2018
Although Plasmodium ovale is considered the cause of only mild malaria, a case of severe malaria due to P. ovale with acute respiratory distress syndrome is reported.
A 37-year old Caucasian man returning home from Angola was admitted for ovale malaria to the National Institute for Infectious Diseases Lazzaro Spallanzani in Rome, Italy. Two days after initiation of oral chloroquine treatment, an acute respiratory distress syndrome was diagnosed through chest X-ray and chest CT scan with intravenous contrast. Intravenous artesunate and oral doxycycline were started and he made a full recovery.
Ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have occasionally been reported. In this case clinical failure of oral chloroquine treatment with clinical progression towards acute respiratory distress syndrome is described.
Although Plasmodium ovale is considered the cause of only mild malaria, some reports indicate the potential evolution to severe disease and even death . A case of severe ovale malaria with acute respiratory distress syndrome (ARDS) unresponsive to previous therapy with chloroquine is reported.
Discussion and conclusion
Ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have previously been reported .
In this case, clinical failure of oral chloroquine treatment in a patient with ovale malaria is described. Plasmodium ovale infection was confirmed by nested-PCR targeting the small sub-unit ribosomal RNA gene, detecting at least 10 parasite genomes per reaction and mixed infection with other Plasmodium spp were excluded . Persistent P. ovale parasitaemia during the first 48 h of oral chloroquine therapy was associated with clinical progression towards ARDS. Only 1 day after the switch to iv artesunate, the parasitaemia clearance was reached and the patient’s condition improved. Chloroquine is commonly used for the treatment of P. ovale infection. In non-falciparum malaria, resistance to chloroquine is reported only for Plasmodium malariae whereas P. ovale is usually considered fully chloroquine susceptible .
Moreover, in a systematic review to determine the efficacy and safety of artemisinin-based combined therapy (ACT) for the treatment of non-falciparum malaria, ACT was considered at least equivalent to chloroquine in effectively treating non-falciparum malaria .
Characteristics of previous cases of ARDS in Plasmodium ovale malaria
P. ovale subtype (wallikeri/curtisi)
Origin of infection
Time since exposition (days)
History of tuberculosis
Chloroquine phosphate + primaquine, quinine, artesunate
Chad ivory coast
DA, GTS and MI performed the clinical assessments, treated the patient and drafted the manuscript. SL, OA and CA performed the clinical assessments and treatment, searched the literature and drafted the manuscript. PMG performed molecular diagnostic tests and drafted the manuscript. DA and NE performed literature search, drafted and completed the manuscript. All authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Availability of data and materials
Consent for publication
Written informed consent was obtained from the patient for publication of this case report.
Ethics approval and consent to participate
Institutional Review Board approval is not required by the Ethical Committee of the authors’ institution for the presentation of a single case report.
Publication of this report was supported by Ricerca Corrente and Ricerca finalizzata WFR PE-2013-02357936 funded by the Italian Ministry of Health.
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