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Clearance kinetics of parasites and pigment-containing leukocytes in severe
malaria
NP Day, TD Pham, TL Phan, XS Dinh, PL Pham, VC Ly, TH Tran, TH Nguyen, DB Bethell, HP Nguyan, TH Tran and NJ White
Centre for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam.
In tropical areas, where unsupervised use of antimalarial drugs is common,
patients with an illness consistent clinically with severe malaria but with
negative blood smears pose a management dilemma. Malaria pigment is evident
in peripheral blood leukocytes in greater than 90% of patients with severe
malaria. To characterize the clearance kinetics of parasitized erythrocytes
and malaria pigment-containing leukocytes, sequential peripheral blood and
intradermal smears were assessed in 27 adult Vietnamese patients with
severe falciparum malaria. The clearance of parasitized erythrocytes and
pigment- containing monocytes (PCMs) followed first order kinetics. The
elimination of pigment-containing neutrophils (PCNs) was first order
initially, but deviated from this when counts were low. Clearance of
peripheral blood PCMs (median clearance time, 216 hours; range, 84 to 492
hours) was significantly slower than that of parasitized erythrocytes
(median, 96 hours; range, 36 to 168 hours) or PCNs (median, 72 hours;
range, 0 to 168 hours; P < .0001). Intradermal PCM clearance times were
the longest of all (median, 12 days; range, 6 to 23 days; significantly
longer than peripheral blood PCM clearance, P < .001). Twenty-one (88%)
patients still had signs, symptoms, or laboratory features of severe
malaria after parasite clearance but before phagocyte pigment clearance.
Sixteen of the 23 surviving patients (70%; 95% confidence interval, 50% to
87%) still had intraleukocytic malaria pigment on peripheral blood films 72
hours after parasite clearance. Thus, by determining the distribution of
malaria pigment in peripheral blood and intradermal phagocytes, the time
since effective antimalarial treatment started can be estimated. Microscopy
for intraleukocytic pigment is valuable in the differential diagnosis of
severe febrile illnesses in malarious areas where uncontrolled use of
antimalarial drugs is widespread.
Volume 88,
Issue 12,
pp. 4694-4700,
12/15/1996
Copyright © 1996 by The American Society of Hematology
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