A hemophagocytic syndrome (include hemophagocytic lymphohistiocytosis) may be triggered by a malaria infection. The infection triggers a systemic disorder related to immune dysregulation.
Pathogenesis: uncontrolled activation of macrophages due to release of cytokines from cytotoxic T-cells
Reported cases have primarily been associated with Pl. falciparum or Pl. vivax. In theory, any species could trigger the reaction.
Patient selection: malaria
Clinical features:
(1) high-grade fever
(2) anemia, neutropenia and thrombocytopenia
(3) splenomegaly
(4) a systemic response that varies in intensity, sometimes with multi-organ failure and shock
Laboratory findings include:
(1) elevated serum ferritin concentration (> 500 ng/mL)
(2) evidence of hemophagocytosis in bone marrow or other biopsy
(3) increased serum concentrations of soluble CD25
(4) hypofibrinogenemia
Other causes of a hemophagocytic syndrome should be excluded.
It is also necessary to distinguish hemophagocytic syndrome from severe malaria without the macrophage activation.
