Institute of Infectious Diseases, University of Bari, Italy.
BMC Infect Dis. 2010 Apr 1;10:87. doi: 10.1186/1471-2334-10-87.
Co-infection with Plasmodium falciparum malaria and Parvovirus B19 in adults is an extremely rare occurrence and, apparently, only one case has been previously reported. Herein we describe a case of acute co-infection with severe anemia and renal failure.
The patient was a 34-year-old African man presenting myalgia, fatigue, headache, anemia and hepatosplenomegaly. A thin peripheral smear showed Plasmodium falciparum trophozoites and the patient was treated with oral mefloquine. After an initial amelioration, fever, fatigue and myalgia reappeared, the anemia worsened and there was evidence of acute renal failure. No malarial parasites were found with a blood smear. A bone marrow aspiration showed marked erythroid hypoplasia. Parvovirus B19-specific IgM and IgG and viremia were positive. The patient was treated with steroids and blood cell transfusions. After ten days, anemia and renal failure progressively decreased. When last seen, the patient was asymptomatic and the blood values were within the normal range.
The diagnosis of Parvovirus B19 acute infection should be considered in any case of persistent severe anemia and/or renal failure, even in clinical conditions that are well-known causes of anemia and renal failure, such as malaria.
成人中疟原虫恶性疟疾与细小病毒 B19 的合并感染极其罕见，据报道仅有一例。在此我们描述了一例急性合并感染导致严重贫血和肾衰竭的病例。
患者为 34 岁非洲男性，表现为肌肉痛、疲劳、头痛、贫血和肝脾肿大。外周血涂片显示恶性疟原虫滋养体，给予患者口服甲氟喹治疗。初始缓解后，发热、疲劳和肌肉痛再次出现，贫血恶化并出现急性肾衰竭。血涂片未见疟原虫。骨髓抽吸显示明显的红系发育不良。细小病毒 B19 特异性 IgM 和 IgG 及病毒血症阳性。患者接受了皮质类固醇和血细胞输注治疗。十天后，贫血和肾衰竭逐渐改善。最后一次就诊时，患者无症状，血液值恢复正常范围。
对于持续性严重贫血和/或肾衰竭的任何病例，即使在已知贫血和肾衰竭病因的临床情况下，也应考虑细小病毒 B19 急性感染的诊断。
