Acute Renal Failure In A Caucasian Traveler With Severe Malaria: A Case Report

Abstract

Introduction Malaria is an Italian word composed of “mala” and “aria”, derived from malus (bad) and aeris (air). It is a disease caused by a protozoan parasite of the genus Plasmodium, namely, P. falciparum, P. vivax, P. malariae, and P. ovale, while P. Knowles commonly affects nonhuman primates [1]. The parasite is transmitted by an infected female Anopheles mosquito. The disease remains to be the major cause of morbidity and mortality in many tropical developing countries where it is mostly caused by Plasmodium falciparum [2]. It is estimated that the latter causes around 600,000 deaths annually and the vast majority of such deaths occur in sub-Saharan African countries [3]. The high mortality rates caused by P. falciparum are to a great extent attributed to the parasite’s ability to induce severe malaria associated with life-threatening complications such as cerebral malaria (CM), acute renal failure (ARF), severe anemia, acidosis, respiratory distress, jaundice, and acute respiratory distress syndrome (ARDS) [2]. Plasmodium falciparum malaria presenting symptoms and mortality pattern vary considerably according to geographical distribution, parasite’s transmission intensity, and host’s immunity to the parasite [3]. In areas with high and stable malaria transmission, for instance, severe malaria is common in children under 5 years of age and commonly presents as severe anemia, while adults with acquired immunity to the parasite do not usually suffer severe malaria. In areas with moderate malaria transmission intensity, however, severe malaria commonly presents as CM in young children. Likewise, in low unstable malaria transmission intensity, severe malaria occurs in all age groups and can manifest as, CM, renal failure, severe jaundice, and/or pulmonary edema [3, 4]. However, ARF has been reported to be one of the most common complications of falciparum malaria in nonimmune adults [2, 4, 5]. Malarial Acute Renal Failure (MARF) can occur as an isolated complication or as a component of multiorgan involvement. Indeed, an association of ARF and CM has been reported and found to cause relatively higher mortality rates than CM alone [2]. MARF should be suspected when urine output falls to less than 400 mL/ 24 h or 20 mL/h despite adequate rehydration and the diagnosis is confirmed when serum creatinine exceeds