Somnath Maji¹, Boudhayan Bhattacharjee²*, Avisek Gon¹, Olivia Bhattacharya¹, Koushik Mukherjee¹, Arunansu Talukdar³ and Udas Chndra Ghosh³

¹Junior Resident, Department of General Medicine, Medical College, Kolkata, India
²RMO Cum Clinical Tutor, Department of General Medicine, Medical College, Kolkata, India
³Professor, Department of General Medicine, Medical College, Kolkata, India

*Corresponding Author: Boudhayan Bhattacharjee, RMO Cum Clinical Tutor, Department of General Medicine, Medical College, Kolkata, India

Received: August 23, 2021; Published: September 23, 2021

Abstract

  Both Plasmodium vivax malaria and Scrub Typhus has numerous reported neurological complications. In our case a middle-aged man presented with quadriparesis with history of high-grade fever with chills and rigor. On investigation, serum potassium found to be low and Plasmodium vivax schizont was found in blood smear. Patient started intravenous Potassium supplementation along with Anti-malarial therapy. Weakness improved within 48 hours of potassium supplementation, but fever persists after three days of antimalarials. On through examination we found an eschar in the back region and subsequently Scrub Typhus serology (IgM) came Positive, fever subsided after starting Doxycycline. Hypokalemia often seen in children with Plasmodium falciparum malaria infection. But co-infection of Plasmodium vivax malaria with Scrub typhus can also cause severe form of hypokalemia which may lead to even hypokalemic quadriparesis. This is very much atypical presentation in a rickettsia and parasitic co-infection which has not been previously reported.

Keywords: Plasmodium vivax; Scrub Typhus; Co-Infection; Hypokalemic Quadriparesis

References

1. Mahajan SK.” Scrub typhus”. Journal of the Association of Physicians of India 53 (2005): 954-958.
2. Mansanguan C and Phumratanaprapin W. “Concomitant Plasmodium vivax malaria and murine typhus infection with pulmonary involvement”. BMJ Case Report1 (2018): e226139.
3. Sharma A., et al. “Rare Coinfection of Scrub Typhus and Malaria in Immunocompetent Person”. Online Journal of Health and Allied Sciences: OJHAS 2 (2012): 12.
4. Venkata Krishna P., et al. “Mixed infection with plasmodium vivax malaria and scrub typhus”. Journal of Clinical and Scientific Research 4 (2015): 265-267.
5. Rani A., et al. “Electrolyte Disturbance and the Type of Malarial Infection”. Iranian Journal of Public Health11 (2015): 1492-1497.
6. Maitland K., et al. “Hypokalaemia in children with severe falciparum malaria”. Pediatric Critical Care Medicine 5 (2004): 81-85.
7. Jasani JH., et al. “Association of the electrolyte disturbances (Na+, K+) with the type and severity of the malarial parasitic infection”. Journal of Clinical and Diagnostic Research 6 (2012): 678-681.
8. Thanachartwet V., et al. “Hyponatraemia and hypokalaemia in adults with uncomplicated malaria in Thailand”. Tropical Doctor 3 (2008): 155-157.
9. Grover R and Mehalingam V. “Acute kidney injury and electrolyte abnormalities in patients with scrub typhus admitted to a tertiary care hospital in southern India”. Journal of Family Medicine and Primary Care 10 (2021): 187-191.
10. Kumar S., et al. “Renal manifestations of scrub typhus - in a tertiary care centre of North India 2018-19”. International Journal of Health Sciences and Research 3 (2020): 48-54.
11. Garg RK., et al. “Neurological manifestations of malaria: an update”. Neurology India 47 (1999): 85-91.
12. , et al. “Hypokalaemic paralysis in an adult case of Plasmodium vivax malaria”. Malaria Journal 12 (2013): 111.

Citation

Citation: Boudhayan Bhattacharjee., et al. “Hypokalemic Quadriparesis in a case of Plasmodium vivax and Scrub Typhus Co-Infection - A Case Report From Eastern India". Acta Scientific Neurology 4.10 (2021): 45-48.

Copyright

Copyright: © 2021 Boudhayan Bhattacharjee., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.