title: Severe Plasmodium knowlesi malaria in a tertiary care hospital, Sabah, Malaysia.
abstract: The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007-November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1-2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.
authors.affiliation: Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysian Borneo.
authors.forename: Timothy
authors.initials: T
authors.lastname: William
authors.forename: Jayaram
authors.initials: J
authors.lastname: Menon
authors.forename: Giri
authors.initials: G
authors.lastname: Rajahram
authors.forename: Leslie
authors.initials: L
authors.lastname: Chan
authors.forename: Gordon
authors.initials: G
authors.lastname: Ma
authors.forename: Samantha
authors.initials: S
authors.lastname: Donaldson
authors.forename: Serena
authors.initials: S
authors.lastname: Khoo
authors.forename: Charlie
authors.initials: C
authors.lastname: Frederick
authors.forename: Jenarun
authors.initials: J
authors.lastname: Jelip
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Anstey
authors.forename: Tsin Wen
authors.initials: TW
authors.lastname: Yeo
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage* / Q000627:therapeutic use; D000077332:Artesunate; D002738:Chloroquine / Q000008:administration & dosage / Q000627:therapeutic use; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage / Q000627:therapeutic use; D006786:Hospitals, Urban; D006801:Humans; D000078102:Lumefantrine; D008288:Malaria / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000469:parasitology / Q000503:physiopathology; D008296:Malaysia / Q000453:epidemiology; D008853:Microscopy; D008875:Middle Aged; D018512:Parasitemia / Q000097:blood; D018579:Patient Selection; D016790:Plasmodium knowlesi / Q000187:drug effects / Q000502:physiology*; D016133:Polymerase Chain Reaction; D011803:Quinine / Q000008:administration & dosage / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000503:physiopathology; D012720:Severity of Illness Index; D012769:Shock / Q000503:physiopathology; D015996:Survival Rate
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000077332:Artesunate; D002738:Chloroquine; D011803:Quinine; D000077549:Artemether; D000078102:Lumefantrine