[Postmortem diagnosis of tropical malaria].
Thirteen days after returning from a four week holiday in Kenya a 35-year-old man consulted his doctor complaining of feeling unwell. The doctor diagnosed influenza and gave him a sickness certificate for three days. Because the patient did not reappear at his workplace a search was made and he was found dead in his flat seven days after seeing his doctor. A medicolegal autopsy was performed two days after the estimated time of death. There was marked swelling of liver and spleen together with jaundice and "dirty grey" colouration of the viscera. Samples of heart blood and spleen puncture material were taken. Giemsa stained preparations (ordinary and thick blood smears) revealed numerous objects 1.2 to 1.5 microns in size with indistinct reddish blue staining, some of them arranged in rosettes reminiscent of schizonts. A few of them contained pigment. In material from the spleen there were masses of blackish-brown pigment. The malaria immunofluorescence test performed on serum gave a weakly positive titre of 1:40. The findings were considered enough to support a diagnosis of fulminant falciparum malaria, and this was confirmed by histological changes in various organs, notably the typical capillary blockages in the brain. Because of the popularity of long-haul tourism, cases of imported malaria are increasingly frequent and, in view of the insidiously progressive course of the disease, it should always be considered in the differential diagnosis. In cases of unexplained death, if there is any suspicion of malaria, blood should always be taken for appropriate investigations, in addition to blocks for histological examination.
Albert
S
S
Abteilung für Medizinische Mikrobiologie im Zentrum der Hygiene sowie Zentrum der Rechtsmedizin, Klinikum der Universität Frankfurt/Main.
Schröter
A
A
Bratzke
H
H
Brade
V
V
D000328:Adult; D001344:Autopsy; D001921:Brain / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005858:Germany; D006801:Humans; D007630:Kenya; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D016779:Malaria, Cerebral / Q000473:pathology*; D016778:Malaria, Falciparum / Q000473:pathology*; D008297:Male; D009206:Myocardium / Q000473:pathology; D018512:Parasitemia / Q000473:pathology; D013154:Spleen / Q000473:pathology; D014195:Travel
Postmortale Diagnose einer Malaria tropica.