alexa Malarial Myocarditis: A Rare Complication of Plasmodium vivax: Case Report | Open Access Journals
ISSN: 2165-7920
Journal of Clinical Case Reports
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Malarial Myocarditis: A Rare Complication of Plasmodium vivax: Case Report

Sandeep Kumar*, Srikant Behera and Adil Ahmad Khan

Department of Medicine, Jawahar Lal Nehru Medical college, AMU, India

*Corresponding Author:
Sandeep Kumar
Department of Medicine, Jawahar Lal
Nehru Medical college, AMU, India
Tel:
05712700920
E-mail: sandeep.jnmc@gmail.com

Received date: February 14, 2017; Accepted date: March 20, 2017; Published date: March 25, 2017

Citation: Kumar S, Behera S, Khan AA (2017) Malarial Myocarditis: A Rare Complication of Plasmodium vivax: Case Report. J Clin Case Rep 7:945. doi:10.4172/2165-7920.1000945

Copyright: © 2017 Kumar S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Clinical Case Reports

Abstract

Malaria is one of the commonest parasitic diseases in the tropical countries like India. Complications of P. falciparum malaria are well recognised, but the complications of P. vivax malaria still continues to give us surprises. Myocardial involvement is a very rare complication of P. vivax infection. In this context, we report a case of P. vivax induced myocarditis and sinus exit block in our patient with review of the literature related to this rare entitiy.

Keywords

Complication; Malaria; Myocarditis; Plasmodium vivax

Case Report

A 22 year male presented with complains of intermittent fever with rigor since 8 days and jaundice since last 4 days, fever was high grade and associated with shortness of breath and palpitations. There was no history of previous cardiac disease, skin rash, swelling over body, decreased urine output, or bleeding from any site. There was no previous similar complains in past. Family history was unremarkable. Patient was student having no history of addiction of tobacco or alcohol, blood transfusion or sexual contact. On examination, he was conscious and oriented, his vitals were pulse rate of 120/min regular low volume, blood pressure was 100/60 mmHg, respiratory rate of 26/min and temperature of 101°F, his peripheral oxygen saturation was 93% at room air. He was ecteric and mild pallor was present with tender hepatomegaly of total liver span of 18 cm and nontender, firm spleen was palpable 4 cm below the left costal margin. chest was clear with normal breath sound. Rest of the examination was unremarkable. His investigations showed haemoglobin -8 gm/dl, TLC-9.2 × 109/L, platelet count 80 × 109/L. Liver function tests documented indirect hyper bilirubinaemia, with normal blood glucose level, PT/INR values and renal function test and cardiac enzymes was normal. Peripheral smear showed ring and schizont stage of P. vivax, with no toxic granules. Optimal test was positive for P. vivax only. Widal test, Leptospira slide macro agglutination test was negative. Viral serology for Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E, HIV were negative. ECG showed sinus exit block (Figure 1). Chest X-ray suggested cardiomegaly (Figure 2). Echocardiography was carried out, which was suggestive of dilated left ventricle and left atrium with moderate mitral regurgitation, severe LV systolic dysfunction, ejection fraction of 25% (Figure 3). Cardiac enzymes were negative. A diagnosis of P. vivax induced myocarditis was made and the patient was treated with intravenous Artesunate, IV fluids and antipyretics, after which, the patient improved clinically. A repeat echocardiography carried out after 8 days showed reduction in LV cavity dimension and improvement in cardiac function with Ejection fraction of 50% to 55%, with no MR. Also, the ECG changes reverted to normal after 8 days.

clinical-case-reports-sinus-exit-block

Figure 1: ECG showing sinus exit block.

clinical-case-reports-showing-cardiomegaly

Figure 2: Chest X-ray showing cardiomegaly.

clinical-case-reports-echocardiography

Figure 3: Apical 4 chamber view showing dilated LV cavity on echocardiography.

Discussion

Malarial fever is an important public health problem in India. More than two-thirds of the Indian population lives in malaria endemic zone. Though P. vivax accounts for nearly 50% of total malaria cases, it is rarely associated with serious complications like impaired consciousness with unarousable coma, jaundice, progressive renal impairment, metabolic acidosis, hyperlactataemia and hypoglycaemia, respiratory distress, pulmonary oedema, severe anaemia, retinal haemorrhage and splenic infarction [1]. Various cardiac complications of malaria include: myocarditis, bundle branch block, pericardial effusion and cardiomyopathy [2]. Nearly all reported cases of cardiac complications of malaria have been limited to P. falciparum. Myocarditis as a complication of P. vivax is a very rare complication. The exact mechanism of cardiac complication associated malaria is not clear. The P. vivax has been demonstrated to cause both sequestration related as well as non-sequestration related complications of severe malaria [3]. The various possible pathogenesis are Plasmodium induced myocarditis includes (1) mechanical blockage of capillaries by malaria parasite and parasitized red blood cells, (2) myocardial damage by pigment laden macrophages, (3) toxic effects of tumour necrosis factor (TNF) on myocardium, (4) fatty change in the myocardium and capillary fibrin thrombi (5) hypoglycaemia and acidosis caused by severe malaria may impair the myocardial integrity and function (6) increase thrombospondin secretion which enhances the sequestration of knobbearing parasitized red cells [4].

ECG and Echocardiography are usually helpful in diagnosing cardiac complications and myocardial dysfunction. ECG may show conduction block and/or T-ST changes. This suggests that the electrophysiology of cardiac myocytes altered before myocytolysis occurs [4]. A regional wall abnormality would suggest myocarditis or coronary artery disease.

Treatment of myocarditis due to P. vivax is rest and to avoid exertional activities and similar as that of myocarditis due to other causes.

In our case patient was presented with complains of fever, jaundice and shortness of breath, on work up there was anaemia, thrombocytopenia, hyperbilirubinemia, cardiomegaly in chest X-ray and sinus exit block in ECG.

In view of complain of shortness of breath, sinus exit block in ECG and cardiomegaly in chest X-ray echocardiography was done which shows dilated left ventricle with moderate MR and enlarged left atrium. In our case, cardiac enzymes were not elevated. In a study, it was seen that the serum concentration of cardiac troponin T was found to be elevated in only 0.6% of patients [5]. Cardiac complications due to vivax malaria are extremely rare. Gupta et al. reported a case of P. vivax induced myocarditis with pericardial effusion 20-years young boy [6]. Soon et al. reported a case of myocarditis associated with P. vivax in a 27 years young woman [7] and Mustafa et al. [8] also reported a case of P. vivax myocarditis in a child.

Conclusion

Now-a-days, P. vivax is manifesting with uncommon complications, which may be lethal. We report on a case of P. vivax infection complicated by myocarditis and first degree AV block. It is important to consider a possible cardiac complication when patients have shortness of breath and retrosternal discomfort. Thus, P. vivax should not be considered a benign infection anymore.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

  • Global Experts meeting on Oncology Case Reports
    Aug 29-31, 2017 London, UK
  • Global Experts Meeting on Case Reports
    Osaka, Japan October 09-11, 2017
  • 6th Global Experts Meeting on Medical Case Reports
    October 16-18, 2017 San Francisco, California, USA

Article Usage

  • Total views: 181
  • [From(publication date):
    March-2017 - Jul 24, 2017]
  • Breakdown by view type
  • HTML page views : 159
  • PDF downloads :22
 
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

agrifoodaquavet@omicsonline.com

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

clinical_biochem@omicsonline.com

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

business@omicsonline.com

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

chemicaleng_chemistry@omicsonline.com

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

environmentalsci@omicsonline.com

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

engineering@omicsonline.com

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

generalsci_healthcare@omicsonline.com

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

genetics_molbio@omicsonline.com

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

immuno_microbio@omicsonline.com

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

omics@omicsonline.com

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

materialsci@omicsonline.com

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

mathematics_physics@omicsonline.com

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

medical@omicsonline.com

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

neuro_psychology@omicsonline.com

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

pharma@omicsonline.com

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

social_politicalsci@omicsonline.com

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version