Plasmodium falciparum and Mycoplasma pneumoniae co-infection presenting with cerebral malaria manifesting orofacial dyskinesia and haemophagocytic lymphohistiocytosis.
Malaria is a mosquito-borne infectious disease with diverse clinical manifestations caused by a parasitic protozoan of the genus Plasmodium. Complex inter-relationships between Mycoplasma species and Plasmodium parasites have been previously noted in vitro. This is the first report of Plasmodium falciparum and Mycoplasma pneumoniae co-infection in a human host presenting with cerebral malaria manifesting orofacial dyskinesias and haemophagocytic lymphohistiocytosis.



A 55-year-old Sri Lankan man with a recent visit to South Africa presented with an acute febrile illness, cough and worsening dyspnoea with alveolar-interstitial infiltrates on chest radiography. Serological evaluation confirmed a diagnosis of Mycoplasma infection. He subsequently developed encephalopathy with orofacial dyskinesia. A diagnosis of severe P. falciparum infection with significant parasitaemia was established. Peripheral blood cytopaenia occurred due to haemophagocytic lymphohistiocytosis in the bone marrow. Complete clinical and haematological recovery was achieved with intravenous artesunate.



Plasmodium falciparum and Mycoplasma pneumoniae co-infection occurring in vivo manifests clinical features that are plausibly a result of the interaction between the two microorganisms. This is the first report of orofacial dyskinesia in either infection.
University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Praveen
P
Weeratunga
University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Gowri
G
Rathnayake
University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Ahalya
A
Sivashangar
University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.|Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka.
Panduka
P
Karunanayake
University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.|Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka.
Ariaranee
A
Gnanathasan
University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka. thashichang@gmail.com.|Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo 08, Sri Lanka. thashichang@gmail.com.
Thashi
T
Chang
D060085:Coinfection / Q000150:complications*; D020820:Dyskinesias / Q000150:complications / Q000473:pathology*; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications / Q000473:pathology*; D016779:Malaria, Cerebral / Q000150:complications / Q000473:pathology*; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009175:Mycoplasma Infections / Q000150:complications*; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification; D010963:Plasmodium falciparum / Q000302:isolation & purification; D013019:South Africa; D013188:Sri Lanka
Haemophagocytic lymphohistiocytosis; Malaria; Mycoplasma; Orofacial dyskinesia; Sri Lanka