Health Sciences Centre, Federal University of Acre, BR 364 KM 04, Rio Branco, Acre, Brazil.
Malar J. 2014 Feb 18;13:61. doi: 10.1186/1475-2875-13-61.
A child living in the Brazilian Amazon region who had had vivax malaria at the age of 11 months was admitted three months later with a history of progressive dyspnoea and fever, which culminated in respiratory distress and severe dilated cardiomyopathy at hospital admission in a malaria-free area. She received treatment for cardiac insufficiency and was tested for malaria with two thick blood smears, which were negative. There was general improvement of cardiorespiratory function in the next two weeks, but in the third week of hospital admission, there was re-appearance of fever, severe anaemia, severe plaquetopaenia, and respiratory distress. A third thick blood smear was positive for Plasmodium vivax mono-infection, which was confirmed by molecular methods. A serological panel with the most prevalent infectious agents known to cause myocarditis was performed, and specific anti-cytomegalovirus (CMV) IgM and elevated levels of anti-CMV IgG were also detected in the serum. After treatment for malaria, there was improvement of respiratory distress, although cardiac function did not recover. She was discharged home with drugs for cardiac insufficiency and is currently under follow-up with a paediatric cardiologist as an outpatient. This report presents a young child with several episodes of vivax malaria who suffers from cardiac insufficiency, probably related to CMV-induced myocarditis.
一名居住在巴西亚马逊地区的 11 个月大的儿童曾患有间日疟，三个月后因进行性呼吸困难和发热而入院，在无疟疾地区的医院入院时，最终发展为呼吸窘迫和严重扩张型心肌病。她因心功能不全接受了治疗，并进行了两次厚血涂片检查以排除疟疾，但均为阴性。在接下来的两周内，心肺功能有了总体改善，但在入院的第三周，出现了再次发热、严重贫血、严重血小板减少和呼吸窘迫。第三次厚血涂片检查显示间日疟原虫单感染阳性，分子方法也证实了这一点。进行了一个针对最常见的已知可引起心肌炎的感染性病原体的血清学检测，血清中还检测到了特异性抗巨细胞病毒（CMV）IgM 和升高的抗 CMV IgG。疟疾治疗后，呼吸窘迫得到改善，尽管心功能没有恢复。她出院时带了治疗心功能不全的药物，目前正在儿科心脏病专家的门诊接受随访。本报告介绍了一名儿童反复发作间日疟，患有心功能不全，可能与 CMV 诱导的心肌炎有关。
