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Plasmodium knowlesi Malaria

57:16 recording · AUTO · 3 speakers

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Brief overview

A Malaysian man's daily fevers after a jungle trip turn out to be Plasmodium nolsi malaria.

  1. Daily fever points to P. nolsiThe 24-hour replication cycle gives a quotidian fever that separates it from the tertian and quartan species.
  2. Fever in the tropics is malaria until proven otherwiseJason's email applies the adage and asks for an immediate thick and thin blood smear under oil microscopy.
  3. Medical science was wrong for seventy yearsP. nolzi was identified in 1931 and thought to spare humans until 2004; Malaysia reported 2,500 cases and nine deaths in 2022.
Executive Summary AI
  • Daniel Griffin presents the case of a man in his late 30s from Kuching, Sarawak, admitted in December with daily fevers, shaking chills and headache after a jungle trip a couple of weeks earlier, with low white cells, anemia, a platelet count of less than 50,000, abnormal coagulation, elevated creatinine and elevated serum aminotransferases.2:08
  • Every listener guess read out — students from the University of Washington and the University of Oklahoma parasitology class, plus physicians and returning champions — lands on Plasmodium nolsi, citing the 24-hour fever periodicity, the macaque reservoir in Sarawak, the December rainy season and the evening-biting Anopheles mosquitoes.3:31
  • Daniel confirms that the blood smear gave exactly that diagnosis, that it was no surprise to the local physicians, and that the patient did well in an area used to recognising this infection.42:08
  • Christina Naula reports on PubMed work modelling Malaysian surveillance records from 2011 to 2021 that found no sustained non-zoonotic P. nolsi transmission, and a second paper tying that to gametocytes appearing in only around 5% of smears — far below Vivax — even though parasitemia can reach 10%.43:03
  • The episode closes with a new case from northern Tanzania near the Kenyan border: a 32-year-old pregnant woman in her second trimester, dehydrated after three plus weeks of sticky stools with blood mixed in, drinking river water, HIV negative, with low hemoglobin and elevated creatinine, and a hint that Hickam rather than Occam applies.52:16
Key Quote
“And so, yeah, P. nulzi is quite clear.”
— Vincent Racaniello41:29
Key Quote
“Yes, that is what the diagnosis turned out to be.”
— Daniel Griffin42:08
Key Quote
“so I was doing some digging on PubMed not not on Google I shall say”
— Christina Naula42:47