Invasive Aspergillus fumigatus infection after Plasmodium falciparum malaria in an immuno-competent host: Case report and review of literature

There is strong evidence that malaria can lead to altered immune response via modulation of both humoral and cell-mediated immunity. Therefore, Plasmodium falciparum malaria with subsequent transient immunosuppression can lead to opportunistic infections in previously immunocompetent patients [1].Aspergillosis (Aspergillus spp.) is a major cause of morbidity and mortality in immuno-suppressed hosts, such as patients with haematological malignancies and transplant recipients. Aspergillus spp. is found ubiquitously in the environment worldwide and reaches the alveoli by airborne transmission. In healthy persons, the spores are eliminated by mucociliary clearance and pulmonary macrophages. Although infection in healthy individuals can occur, invasive aspergillosis is extremely uncommon in immuno-competent hosts. There are only four reported cases of invasive aspergillosis complicating falciparum malaria in immuno-competent hosts, all with fatal outcome [2-4].A 58-year old Caucasian man returned from an 11-day vacation in the Dominican Republic. He had no previous medical history and no malaria prophylaxis was taken.Six days after return, he developed a fever of up to 40.5°C and dark-coloured watery diarrhoea with nausea and vomiting. His general practitioner suggested a viral infection and treated him with ibuprofen. The fever remained high and on the 7th day of illness, his general condition deteriorated. On presentation at the hospital, he additionally was complaining of pain upon swallowing.On admission, he was sleepy, but fully oriented, afebrile and pale. No signs of meningitis were found. The lungs were clear and the heart sounds normal. BP was 150/85 mmHg and the pulse rate 95/min. Blood films showed P. falciparum with a parasitaemia of 9.5%. Initial laboratory results were Hb 14.6 g/dl, WBC 8.14/nl, PLT 12/nl, CRP 162.8 mg/l (normal range < 5 mg/l), creatinine 6.09 mg/dl, urea 208 mg/dl, LDH 805 U/l, GOT 69 U/l, GPT 197 U/l. Blood culture, urine culture and ser