title: Co-incidental Plasmodium Knowlesi and Mucormycosis infections presenting with acute kidney injury and lower gastrointestinal bleeding.
abstract: BACKGROUND
  Plasmodium knowlesi is frequently reported in Southeast Asian countries and is now widely regarded as the fifth malarial parasite. Mucormycosis is a rare fungal infection that can occur in patients with a weakened immune system.
  
  
  METHODS
  We report a case of acute kidney injury secondary to Plasmodium knowlesi malaria infection and mucormycosis fungal infection. In addition, the patient also had lower gastrointestinal bleeding from invasive gastrointestinal mucormycosis. P. knowlesi infection was diagnosed by blood film and mucormycosis was diagnosed by histopathological examination of biopsy specimen of the colon. The patient recovered with antimalarial treatment (Quinine), antifungal treatment (Lipophilic Amphotericin), and supportive hemodialysis treatment.
  
  
  CONCLUSIONS
  We hypothesize that P. knowlesi malarial infection can lower the immunologic threshold and predisposes vulnerable individuals to rare disseminated fungal infections. To the best of our knowledge, this is the first P. Knowlesi malaria-associated invasive fungal infection reported in the literature.
authors.affiliation: Department of Renal Medicine, RIPAS Hospital, Brunei-Muara, Brunei.
authors.forename: Arunachalam
authors.initials: A
authors.lastname: Ramaswami
authors.forename: Jayakrishnan K
authors.initials: JK
authors.lastname: Pisharam
authors.forename: Hla
authors.initials: H
authors.lastname: Aung
authors.forename: Kafeel
authors.initials: K
authors.lastname: Ghazala
authors.forename: Khalil
authors.initials: K
authors.lastname: Maboud
authors.forename: Vui Heng
authors.initials: VH
authors.lastname: Chong
authors.forename: Jackson
authors.initials: J
authors.lastname: Tan
keywords: Plasmodium knowlesi; acute kidney injury; gastro-intestinal bleeding; malaria; mucormycosis