Prophylaxis Failure and Successful Management of Delayed-Onset Malaria with Renal Complications: A Case Report with Oral Artemether-Lumefantrine Treatment

IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL
Ilir Tolaj, Gramoz Bunjaku, Murat Mehmeti, Yllka Begolli
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Abstract

This case report presents a critical clinical scenario involving a 55-year-old patient who developed severe Plasmodium falciparum malaria with renal complications despite receiving doxycycline prophylaxis while traveling in a malaria-endemic region. The case emphasizes the potential failure of doxycycline prophylaxis and highlights the importance of considering malaria in patients with a history of travel to endemic areas, even if they have adhered to prophylactic treatment. The patient’s clinical presentation included fever, extreme fatigue, and loss of consciousness, leading to hospitalization. Laboratory findings revealed severe anemia, elevated liver enzymes, and impaired renal function, consistent with the criteria for severe malaria. The diagnosis was confirmed by the presence of Plasmodium falciparum parasites on thin blood smears. Due to limited access to parenteral antimalarial medications in Kosovo, the patient received oral artemether-lumefantrine, resulting in clinical improvement. Supportive care and dialysis played a vital role in the patient’s recovery. This case report underscores the need for increased awareness of prophylaxis failure, the challenges of managing severe malaria in non-endemic countries, and the importance of timely and appropriate interventions to improve outcomes in severe malaria cases, particularly those with renal involvement.
延迟性疟疾伴肾脏并发症的预防失败和成功治疗:口服蒿甲醚-氨苯曲明治疗1例报告
本病例报告提出了一个关键的临床情景,涉及一名55岁患者,尽管在疟疾流行地区旅行时接受了强力霉素预防治疗,但仍出现了严重的恶性疟原虫疟疾并伴有肾脏并发症。该病例强调了强力霉素预防的潜在失败,并强调了在有去过流行地区旅行史的患者中考虑疟疾的重要性,即使他们坚持了预防性治疗。患者的临床表现包括发烧、极度疲劳和意识丧失,导致住院。实验室结果显示严重贫血、肝酶升高和肾功能受损,符合严重疟疾的标准。薄血涂片上发现恶性疟原虫,证实了诊断。在科索沃,由于获得肠外抗疟疾药物的机会有限,患者接受了口服蒿甲醚-氨苯曲明治疗,导致临床改善。支持性护理和透析在患者的康复中发挥了至关重要的作用。本病例报告强调有必要提高对预防失败的认识、在非疟疾流行国家管理严重疟疾的挑战,以及及时和适当干预措施以改善严重疟疾病例,特别是肾脏受累病例预后的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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