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correspondence

Indian Pediatr 2014;51: 320

Splenic Infarction in Plasmodium vivax Malaria

Sunil Taneja and Purvi Mittal

Department of Pediatrics, Madhuraj Hospital, Kanpur, Uttar Pradesh, India.
Email: [email protected]

 


This is in response to a recently reported case of splenic infarction due to vivax malaria [1]. We had a similar child, who on further evaluation was found to have an elevated titer of antiphospholipid IgM. We managed the child with low molecular weight heparin followed by oral warfarin.

In recent years, the association between infections and antiphospholipid syndrome has been reported in several epidemiologic and experimental studies that support the idea of infectious induction of aPL [2]. Witmer, et al. [3] reported two children with Mycoplasma pneumoniae pulmonary infection complicated by the development of splenic infarction and transient antiphospholipid antibodies. Among parasitic infections, malaria and leishmaniasis have been linked with the production of aPL. Avcin and Toplak [4] reviewed 100 antiphospholipid syndrome cases associated with infection and summarized clinical and experimental evidence on the association between aPL and infectious diseases, they also emphasized a possible association with immunizations. Consigny, et al. [5] found a high prevalence of serum cofactor independent aCL, which is a type of antiphospholipid antibody in 137 individuals chronically exposed to Plasmodium falciparum or vivax infections.

We opine that antiphosholipid antibodies should be done in all unusual cases of thrombosis. Anti-phospolipid antibodies usually take 3-6 months to disappear, till that time the patients should be on anticoagulant prophylaxis.

Acknowledgement: Dr Rakhi Jain and Dr Gulnaz Nadri for helping in diagnosis and management of the child.

References

1. Tamaria KC, Agarwal S. Splenic infarction in P.vivax malaria. Indian Pediatr. 2013;50:886.

2. Cervera R, Asherson RA, Acevedo ML. Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics of 100 patients. Ann Rheum Dis. 2004;63:1312-7.

3. Witmer CM, Steenhoff AP, Shah SS, Raffini LJ. Mycoplasma pneumoniae, splenic infarct, and transient antiphospholipid antibodies: a new association? Pediatrics. 2007;119:292-5.

4. Avcin T, Toplak N. Antiphospholipid antibodies in response to infection. Curr Rheumatol Rep. 2007;9:212-8.

5. Consigny PH, Cauquelin B, Agnamey P. High prevalence of co-factor independent anticardiolipin antibodies in malaria exposed individuals. Clin Exp Immunol. 2002;127:158-64.

 

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