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ABSTRACT Acquired thrombotic thrombocytopenic purpura (TTP) is a rare life-threatening disorder characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ damage. We present the case of a 71-year-old man initially diagnosed with malaria-like symptoms and displaying markers of microangiopathic hemolytic anemia, severe thrombocytopenia, renal injury, and neurological impairment. Despite antimalarial treatment, acquired TTP was suspected. Plasma exchange and immunosuppressive therapy led to clinical improvement, normalizing the platelet count and hemolytic profile. Diagnostic confirmation revealed significantly reduced ADAMTS13 levels. Following the proposed treatment, the patient's ADAMTS13 levels normalized. This case illustrates acquired TTP linked to uncomplicated Plasmodium vivax malaria.
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AIMS: To investigate the impact of Plasmodium vivax malaria and chloroquine-primaquine chemotherapy on CYP2D6 and CYP2C19 activity in patients from the Brazilian Amazon. METHODS: Adult patients (n = 30) were given subtherapeutic doses of CYP2D6 and CYP2C19 phenotypic probes metoprolol (10 mg) and omeprazole (2 mg) in three different stages of vivax malaria illness: acute disease (study phase 1), post chemotherapy (phase 2) and convalescence (stage 3). Plasma concentrations of probes and CYP-hydroxylated metabolites (α-OH metoprolol and 5-OH omeprazole) were measured using LC/MS/MS. Two pharmacokinetic metrics were used to estimate CYP activity: (a) ratio of plasma concentrations of probe/metabolite at 240 minutes after administration of the probes and (b) ratio of areas under the time-concentration curves for probe/metabolite (AUC0-12h ). For statistical analysis, the pharmacokinetic metrics were normalized to the respective values in phase 3. Taqman assays were used for CYP2D6 and CYP2C19 genotyping. Cytokines levels were measured using cytometric bead array. RESULTS: Both pharmacokinetic metrics for metoprolol and omeprazole, and plasma concentrations of cytokines IL-6, IL-8 and IL-10 varied significantly across the three study phases (ANOVA P < 0.0001). Post hoc tests showed greater metoprolol:α-OH metoprolol ratios in phases 1 and 2 compared to phase 3, larger omeprazole:5-OH omeprazole ratios in phase 1 than in phases 2 and 3, and higher circulating IL-6, IL-8 and IL-10 in phase 1 than in phases 2 and 3. CONCLUSION: P. vivax malaria and treatment altered CYP2D6 and CYP2C19 metabolic phenotypes. CYP2C19 inhibition is attributed to a higher level of circulating proinflammatory cytokines, while suppression of CYP2D6 is ascribed mainly to chloroquine exposure.
Assuntos
Antimaláricos , Malária Vivax , Adulto , Antimaláricos/uso terapêutico , Brasil , Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2D6/genética , Humanos , Malária Vivax/tratamento farmacológico , Primaquina , Espectrometria de Massas em TandemRESUMO
Objetivos. Determinar la frecuencia y características clínicas de los recién nacidos con malaria congénita en el Hospital de Apoyo de Iquitos en la Amazonía peruana. Materiales y métodos. Estudio descriptivo, prospectivo y transversal. De enero de 2011 a diciembre de 2013 se estudiaron 14 017 recién nacidos y a sus madres, de quienes se seleccionaron 52 portadoras de malaria gestacional mientras que a sus recién nacidos se les hospitalizó en el Servicio de Neonatología del hospital, y fueron sometidos a evaluación clínica y estudios de laboratorio. Resultados. La frecuencia de malaria gestacional fue de 0,4% y una proporción de malaria congénita de 9,6%. Plasmodium vivax fue hallado en 80% de casos de malaria gestacional y en 60% de malaria congénita. Se observó un caso de óbito fetal con gota gruesa positiva para Plasmodium falciparum. El cuadro clínico en recién nacidos fue fiebre, hipoactividad, irritabilidad y pobre succión. Conclusiones. Se documenta la presencia de malaria congénita en recién nacidos de madres con malaria gestacional. El cuadro clínico se asemeja a una sepsis neonatal. El diagnóstico precoz de malaria congénita y el tratamiento oportuno cursan con buena evolución.
Objectives. To determine the frequency and clinical features of newborns with congenital malaria in the Hospital de Apoyo of Iquitos in the Peruvian Amazon. Materials and methods. Descriptive, prospective and cross-sectional study. From January 2011 to December 2013, 14.017 newborns and their mothers were studied, of whom 52 carriers of gestational malaria were selected while their infants were hospitalized in the Neonatology Unit, and underwent clinical assessment and laboratory studies. Results. Gestational malaria frequency was 0.4% and a proportion of 9.6% of congenital malaria. Plasmodium vivax was found in 80% of cases of gestational malaria and in 60% of congenital malaria. A case of fetal death with positive thick blood smear for Plasmodium falciparum was observed. The clinical presentation in newborns was fever, hypoactivity, irritability and poor suction. Conclusions. The presence of congenital malaria in infants born to mothers with gestational malaria is documented. The clinical picture resembled neonatal sepsis. Early diagnosis of congenital malaria and timely treatment present with good evolution.
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Humanos , Masculino , Feminino , Recém-Nascido , Cloroquina , Malária Falciparum , Malária Vivax , Epidemiologia Descritiva , Estudos Prospectivos , Estudos Transversais , PeruRESUMO
Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.