The Phenomenon of the ‘Starry Sky’ on Blood: Lesson Learned From Severe Malaria Falciparum
International Blood Research & Reviews,
Page 141-149
DOI:
10.9734/ibrr/2022/v13i4294
Abstract
Severe malaria occurs when previously uncomplicated malaria infections are then turn to be full blown and tangled by serious, single or multi-organ failures or abnormalities in the patient's blood or metabolism. Clinical deterioration can happen abruptly and unnoticed, due to the masking of other prominent clinical condition like hyperthermia. Making the correct diagnosis as soon as possible is pivotal before administering antimalarial therapy. Diagnosis is made by examining the thick and thin blood films in an attempt to find malaria parasites in the blood sample.The “Starry Sky” appearance is a microscopic feature of severe malaria infection and its exclusively found only in thick blood film. The aim of this minireview is to discuss about the clinical background of “Starry Sky” appearance found in thick blood smear of severe malaria and its brief review combined with our experience in the Deptartment of Parasitology, Faculty of Medicine Universitas Kristen Indonesia, Jakarta-Indonesia, in handled blood test from a vulnerable patient with severe malaria and how we pass on the lessons from that story to our students as part of health communication in community based Parasitology. By inserting this story to our lesson materials, we hope can build awareness among our students as future health practitioners and also to the public they serve as well as all stake holders; this snow ball action are currently and continously required to be done.
Keywords:
- Thick blood smear
- protozoan
- Plasmodium
- vector
- mosquito
- deformability
- lysis
- sequestration
How to Cite
Siagian, F. E. (2022). The Phenomenon of the ‘Starry Sky’ on Blood: Lesson Learned From Severe Malaria Falciparum. International Blood Research & Reviews, 13(4), 141-149. https://doi.org/10.9734/ibrr/2022/v13i4294
References
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Available:https://doi.org/10.1155/2013/841518
World Health organization. Malaria; 2022.
Available:https://www.who.int/news-room/fact-sheets/detail/malaria
White NJ. Severe malaria. Malar J. 2022; 21:284-7.
Available:https://doi.org/10.1186/s12936-022-04301-8
Graça L, Abreu IG, Santos AS, Graça L, Dias PF, et al. Descriptive Acute Respiratory Distress Syndrome (ARDS) in adults with imported severe Plasmodium falciparum malaria: A 10 year-study in a Portuguese tertiary care hospital. PLOS One. 2020;15(7):e0235437.
Available:https://doi.org/10.1371/journal.pone.0235437
Katsoulis O, Georgiadou A, Cunnington AJ. Immunopathology of acute kidney injury in severe malaria. Front Immunol. 2021;12:651739.
Available:https://doi.org/10.3389/fimmu.2021.651739.page
Idro R, Kakooza-Mwesige A, Asea B. et al. Cerebral malaria is associated with long-term mental health disorders: A cross sectional survey of a long-term cohort. Malar J. 2016;15:184-9.
Available:https://doi.org/10.1186/s12936-016-1233-6
Holding PA, Stevenson J, Peshu N, Marsh K. Cognitive sequelae of severe malaria with impaired consciousness. Trans R Soc Trop Med Hyg. 1999;93(5):529-34.
Available:https://doi.org/10.1016/s0035-9203(99)90368-1
Mohapatra M, Dash L, Mishra NR, Agrawala RK. Profile of seizures in adult Falciparum malaria and the clinical efficacy of phenytoin sodium for control of seizures. Asian Pacific Journal of Tropical Disease. 2012;2.
Available:https://doi.org/10.1016/S2222-1808(12)60220-5
Plewes K, Turner G, Dondorp A. Pathophysiology, clinical presentation, and treatment of coma and acute kidney injury complicating Falciparum malaria. Current Opinion in Infectious Diseases. 2018;31(1):69-77.
Available:https://doi.org/10.1097/QCO.0000000000000419
Arakawa C, Gunnarsson C, Howard C, Bernabeu M, Phong K, Yang E, De Forest CA, Smith JD, Zheng Y. Biophysical and biomolecular interactions of malaria-infected erythrocytes in engineered human capillaries. Sci Adv. 2020;6(3): eaay7243.
Available:https://doi.org/10.1126/sciadv.aay7243
Warncke JD, Beck HP. Host Cytoskeleton Remodeling throughout the blood stages of Plasmodium falciparum. Microbiol Mol Biol Rev. 2019;83(4):e00013-19.
Available:https://doi.org/10.1128/MMBR.00013-19.
Depond M, Henry B, Buffet P, Ndour PA. Methods to investigate the deformability of RBC during malaria. Front Physiol. 2020;10:1613.
Available:https://doi.org/10.3389/fphys.2019.01613.
Watermeyer JM, Hale VL, Hackett F, Clare DK, Cutts EE, Vakonakis I, Fleck RA, Blackman MJ, Saibil HR. A spiral scaffold underlies cytoadherent knobs in Plasmodium falciparum-infected erythrocytes. Blood. 2016;127(3):343-51.
Available:https://doi.org/10.1182/blood-2015-10-674002
Dörpinghaus M, Fürstenwerth F, Roth LK, Bouws P, Rakotonirinalalao M, Jordan V, et al. Stringent selection of knobby Plasmodium falciparum-infected erythrocytes during cytoadhesion at febrile temperature. Microorganisms. 2020;8(2):174.
Available:https://doi.org/10.3390/microorganisms8020174
Jensen AR, Adams Y, Hviid L. Cerebral Plasmodium falciparum malaria: The role of PfEMP1 in its pathogenesis and immunity, and PfEMP1-based vaccines to prevent it. Immunol Rev. 2020;293(1):230-252.
Available:https://doi.org/10.1111/imr.12807
Okitawutshu J, Signorell A, Kalenga JC, Mukomena E, Delvento G, Burri C, et al. Danger signs and management of suspected severe malaria cases at community level and in referral health facilities: An operational study in the Democratic Republic of the Congo. Malaria Journal. 2021;21:274.
Available:https://doi.org/10.1186/s12936-022-04296-2
World Health Organization. Management of severe malaria: a practical handbook. World Health Organization; 2000.
Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria diagnosis: A brief review. Korean J Parasitol. 2009;47(2):93-102.
Available:https://doi.org/10.3347/kjp.2009.47.2.93
Giao PT, de Vries PJ, Binh TQ, Nam NV Kager PA. Early diagnosis and treatment of uncomplicated malaria and patterns of health seeking in Vietnam. Tropical Medicine & International Health. 2005;10: 919-25.
Available:https://doi.org/10.1111/j.1365-3156.2005.01472.x
Landier J, Parker DM, Thu AM. The role of early detection and treatment in malaria elimination. Malar J. 2016;15:363.
Available:https://doi.org/10.1186/s12936-016-1399-y
Barsoum RS. Parasitic kidney disease: Milestones in the evolution of our knowledge. Am J Kidney Dis. 2013;61(3):501-13.
Available:https://doi.org/10.1053/j.ajkd.2012.09.025
Sturrock HJW, Roberts KW, Wegbreit J, Ohrt C, Gosling RD. Tackling imported malaria: An elimination endgame. Am J Trop Med Hyg. 2015;93(1):139- 44.
Available:https://doi.org/10.4269/ajtmh.14-0256
Ouédraogo M, Kangoye DT, Samadoulougou S, Rouamba T, Donnen P, Kirakoya-Samadoulougou F. Malaria Case Fatality Rate among Children under Five in Burkina Faso: An assessment of the spatiotemporal trends following the implementation of control programs. Int J Environ Res Public Health. 2020;17(6): 1840.
Available:https://doi.org/10.3390/ijerph17061840
Ouyou-Akotet MK, Offouga CL, Mawili-Mboumba DP, Essola L, Madoungou B, Kombila M. Falciparum malaria as an emerging cause of fever in adults living in Gabon, Central Africa. Biomed Res Int. 2014;2014:351281.
Available:https://doi.org/10.1155/2014/351281.
Possemiers H, Vandermosten L, Van den Steen PE. Etiology of lactic acidosis in malaria. PLoS Pathog. 2021;17(1):e1009122.
Available:https://doi.org/10.1371/journal.ppat.1009122
Mavondo GA, Mavondo J, Peresuh W, Mary Dlodlo M, Moyo O. Malaria pathophysiology as a syndrome: Focus on glucose homeostasis in severe malaria and phytotherapeutics management of the disease. In: Bastidas G, editor. Parasites and Parasitic Diseases. London: Intech Open; 2019. [Internet]
Available:https://doi.org/10.5772/intechopen.79698
Li Q, Weina P. Artesunate: The best drug in the treatment of severe and complicated malaria. Pharmaceuticals (Basel). 2010;3 (7):2322-2332.
Available:https://doi.org/10.3390/ph3072322
Abanyie F, Acharya SD, Leavy I, Bowe M, Tan KR. Safety and effectiveness of intravenous artesunate for treatment of severe malaria in the United States-April 2019 Through December 2020. Clin Infect Dis. 2021;73(11):1965-1972.
Available:https://doi.org/10.1093/cid/ciab570
Sikora SA, Poespoprodjo JR, Kenangalem E. Intravenous artesunate plus oral dihydroartemisinin–piperaquine or intravenous quinine plus oral quinine for optimum treatment of severe malaria: Lesson learnt from a field hospital in Timika, Papua, Indonesia. Malar J. 2019;18:448.
Available:https://doi.org/10.1186/s12936-019-3085-3
Hanson J, Anstey NM, Bihari D, White NJ, Day NP, Dondorp AM. The fluid management of adults with severe malaria. Crit Care. 2014;18(6):642.
Available:https://doi.org/10.1186/s13054-014-0642-6
Nguyen HP, Hanson J, Bethell D, Nguyen TH, Tran TH, Ly VC, et al. A retrospective analysis of the haemodynamic and metabolic effects of fluid resuscitation in Vietnamese adults with severe Falciparum malaria. PLoS One. 2011;6(10):e25523.
Available:https://doi.org/10.1371/journal.pone.0025523
Bhutani A, Kaushik RM, Kaushik R. A study on multi-organ dysfunction syndrome in malaria using sequential organ failure assessment score. Trop Parasitol. 2020;10(2):86-94.
Available:https://doi.org/10.4103/tp.TP_12_19
Agudelo Higuita NI, White BP, Franco-Paredes C, McGhee MA. An update on prevention of malaria in travelers. Ther Adv Infect Dis. 2021;30(8):204993612110 40690.
Available:https://doi.org/10.1177/20499361211040690
Gallay J, Mosha D, Lutahakana E. Appropriateness of malaria diagnosis and treatment for fever episodes according to patient history and anti-malarial blood measurement: A cross-sectional survey from Tanzania. Malar J. 2018;17:209.
Available:https://doi.org/10.1186/s12936-018-2357-7
Tobón A. Signos de peligro en el paciente con malaria [Danger signs in the malaria patient]. Biomedica, Spanish. 2009;29(2):320-9.
PMID: 20128356
World Health Organization. Giemsa staining of malaria blood films; 2016.
Available:https://apps.who.int/iris/bitstream/handle/10665/340462/WHO-HTM-GMP-MM-SOP-2016.07a-eng.pdf?sequence=1
Al Farsi F, Chandwani J, Mahdi AS, Petersen E. Severe imported malaria in an intensive care unit: A case series. ID Cases. 2019;17:e00544.
Available:https://doi.org/10.1016/j.idcr.2019.e00544.
Pasvol G. The treatment of complicated and severe malaria, British Medical Bulletin, 2005;75-76(1):29–47.
Available:https://doi.org/10.1093/bmb/ldh059
Li I, Cheung L. How not to miss a case of malaria in emergency department in malaria non-endemic areas? Practical approach & experiences in Hong Kong. Open Journal of Emergency Medicine. 2016;4:93-109.
Available:https://doi.org/10.4236/ojem.2016.44012.
Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, et al. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLoS Med. 2020;17(10):e1003359.
Available:https://doi.org/10.1371/journal.pmed.1003359
Martínez-Carrillo BE, Elina B, Rillo AG, Castillo-Cardiel JA, García-Arqueta I, Palacios-Jaimes ML. Natural and social history of the health-disease process as an epistemological model for medical education (Part 2). IOSR Journal of Research & Method in Education (IOSR-JRME). 2021;11(1):56-65.
Available:https://doi.org/10.9790/7388-1101035665
Babiker A, El Husseini M, Al Nemri A, Al Frayh A, Al Juryyan N, Faki MO, Assiri A, Al Saadi M, Shaikh F, Al Zamil F. Health care professional development: Working as a team to improve patient care. Sudan J Paediatr. 2014;14(2):9-16.
Sanders JJ, Curtis JR, Tulsky JA. Achieving goal-concordant care: A conceptual model and approach to measuring serious illness communication and its impact. Journal of Palliative Medicine. 2018;21:S2, S-17-S-27.
Available:https://doi.org/10.1089/jpm.2017.0459
Available: https://doi.org/10.1186/cc2183
Thanachartwet V, Desakorn V, Sahassananda D, Kyaw Win KK, Supaporn T. Acute renal failure in patients with severe Falciparum malaria: Using the WHO 2006 and RIFLE criteria. Int J Nephrol. 2013;2013:841518.
Available:https://doi.org/10.1155/2013/841518
World Health organization. Malaria; 2022.
Available:https://www.who.int/news-room/fact-sheets/detail/malaria
White NJ. Severe malaria. Malar J. 2022; 21:284-7.
Available:https://doi.org/10.1186/s12936-022-04301-8
Graça L, Abreu IG, Santos AS, Graça L, Dias PF, et al. Descriptive Acute Respiratory Distress Syndrome (ARDS) in adults with imported severe Plasmodium falciparum malaria: A 10 year-study in a Portuguese tertiary care hospital. PLOS One. 2020;15(7):e0235437.
Available:https://doi.org/10.1371/journal.pone.0235437
Katsoulis O, Georgiadou A, Cunnington AJ. Immunopathology of acute kidney injury in severe malaria. Front Immunol. 2021;12:651739.
Available:https://doi.org/10.3389/fimmu.2021.651739.page
Idro R, Kakooza-Mwesige A, Asea B. et al. Cerebral malaria is associated with long-term mental health disorders: A cross sectional survey of a long-term cohort. Malar J. 2016;15:184-9.
Available:https://doi.org/10.1186/s12936-016-1233-6
Holding PA, Stevenson J, Peshu N, Marsh K. Cognitive sequelae of severe malaria with impaired consciousness. Trans R Soc Trop Med Hyg. 1999;93(5):529-34.
Available:https://doi.org/10.1016/s0035-9203(99)90368-1
Mohapatra M, Dash L, Mishra NR, Agrawala RK. Profile of seizures in adult Falciparum malaria and the clinical efficacy of phenytoin sodium for control of seizures. Asian Pacific Journal of Tropical Disease. 2012;2.
Available:https://doi.org/10.1016/S2222-1808(12)60220-5
Plewes K, Turner G, Dondorp A. Pathophysiology, clinical presentation, and treatment of coma and acute kidney injury complicating Falciparum malaria. Current Opinion in Infectious Diseases. 2018;31(1):69-77.
Available:https://doi.org/10.1097/QCO.0000000000000419
Arakawa C, Gunnarsson C, Howard C, Bernabeu M, Phong K, Yang E, De Forest CA, Smith JD, Zheng Y. Biophysical and biomolecular interactions of malaria-infected erythrocytes in engineered human capillaries. Sci Adv. 2020;6(3): eaay7243.
Available:https://doi.org/10.1126/sciadv.aay7243
Warncke JD, Beck HP. Host Cytoskeleton Remodeling throughout the blood stages of Plasmodium falciparum. Microbiol Mol Biol Rev. 2019;83(4):e00013-19.
Available:https://doi.org/10.1128/MMBR.00013-19.
Depond M, Henry B, Buffet P, Ndour PA. Methods to investigate the deformability of RBC during malaria. Front Physiol. 2020;10:1613.
Available:https://doi.org/10.3389/fphys.2019.01613.
Watermeyer JM, Hale VL, Hackett F, Clare DK, Cutts EE, Vakonakis I, Fleck RA, Blackman MJ, Saibil HR. A spiral scaffold underlies cytoadherent knobs in Plasmodium falciparum-infected erythrocytes. Blood. 2016;127(3):343-51.
Available:https://doi.org/10.1182/blood-2015-10-674002
Dörpinghaus M, Fürstenwerth F, Roth LK, Bouws P, Rakotonirinalalao M, Jordan V, et al. Stringent selection of knobby Plasmodium falciparum-infected erythrocytes during cytoadhesion at febrile temperature. Microorganisms. 2020;8(2):174.
Available:https://doi.org/10.3390/microorganisms8020174
Jensen AR, Adams Y, Hviid L. Cerebral Plasmodium falciparum malaria: The role of PfEMP1 in its pathogenesis and immunity, and PfEMP1-based vaccines to prevent it. Immunol Rev. 2020;293(1):230-252.
Available:https://doi.org/10.1111/imr.12807
Okitawutshu J, Signorell A, Kalenga JC, Mukomena E, Delvento G, Burri C, et al. Danger signs and management of suspected severe malaria cases at community level and in referral health facilities: An operational study in the Democratic Republic of the Congo. Malaria Journal. 2021;21:274.
Available:https://doi.org/10.1186/s12936-022-04296-2
World Health Organization. Management of severe malaria: a practical handbook. World Health Organization; 2000.
Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S. Malaria diagnosis: A brief review. Korean J Parasitol. 2009;47(2):93-102.
Available:https://doi.org/10.3347/kjp.2009.47.2.93
Giao PT, de Vries PJ, Binh TQ, Nam NV Kager PA. Early diagnosis and treatment of uncomplicated malaria and patterns of health seeking in Vietnam. Tropical Medicine & International Health. 2005;10: 919-25.
Available:https://doi.org/10.1111/j.1365-3156.2005.01472.x
Landier J, Parker DM, Thu AM. The role of early detection and treatment in malaria elimination. Malar J. 2016;15:363.
Available:https://doi.org/10.1186/s12936-016-1399-y
Barsoum RS. Parasitic kidney disease: Milestones in the evolution of our knowledge. Am J Kidney Dis. 2013;61(3):501-13.
Available:https://doi.org/10.1053/j.ajkd.2012.09.025
Sturrock HJW, Roberts KW, Wegbreit J, Ohrt C, Gosling RD. Tackling imported malaria: An elimination endgame. Am J Trop Med Hyg. 2015;93(1):139- 44.
Available:https://doi.org/10.4269/ajtmh.14-0256
Ouédraogo M, Kangoye DT, Samadoulougou S, Rouamba T, Donnen P, Kirakoya-Samadoulougou F. Malaria Case Fatality Rate among Children under Five in Burkina Faso: An assessment of the spatiotemporal trends following the implementation of control programs. Int J Environ Res Public Health. 2020;17(6): 1840.
Available:https://doi.org/10.3390/ijerph17061840
Ouyou-Akotet MK, Offouga CL, Mawili-Mboumba DP, Essola L, Madoungou B, Kombila M. Falciparum malaria as an emerging cause of fever in adults living in Gabon, Central Africa. Biomed Res Int. 2014;2014:351281.
Available:https://doi.org/10.1155/2014/351281.
Possemiers H, Vandermosten L, Van den Steen PE. Etiology of lactic acidosis in malaria. PLoS Pathog. 2021;17(1):e1009122.
Available:https://doi.org/10.1371/journal.ppat.1009122
Mavondo GA, Mavondo J, Peresuh W, Mary Dlodlo M, Moyo O. Malaria pathophysiology as a syndrome: Focus on glucose homeostasis in severe malaria and phytotherapeutics management of the disease. In: Bastidas G, editor. Parasites and Parasitic Diseases. London: Intech Open; 2019. [Internet]
Available:https://doi.org/10.5772/intechopen.79698
Li Q, Weina P. Artesunate: The best drug in the treatment of severe and complicated malaria. Pharmaceuticals (Basel). 2010;3 (7):2322-2332.
Available:https://doi.org/10.3390/ph3072322
Abanyie F, Acharya SD, Leavy I, Bowe M, Tan KR. Safety and effectiveness of intravenous artesunate for treatment of severe malaria in the United States-April 2019 Through December 2020. Clin Infect Dis. 2021;73(11):1965-1972.
Available:https://doi.org/10.1093/cid/ciab570
Sikora SA, Poespoprodjo JR, Kenangalem E. Intravenous artesunate plus oral dihydroartemisinin–piperaquine or intravenous quinine plus oral quinine for optimum treatment of severe malaria: Lesson learnt from a field hospital in Timika, Papua, Indonesia. Malar J. 2019;18:448.
Available:https://doi.org/10.1186/s12936-019-3085-3
Hanson J, Anstey NM, Bihari D, White NJ, Day NP, Dondorp AM. The fluid management of adults with severe malaria. Crit Care. 2014;18(6):642.
Available:https://doi.org/10.1186/s13054-014-0642-6
Nguyen HP, Hanson J, Bethell D, Nguyen TH, Tran TH, Ly VC, et al. A retrospective analysis of the haemodynamic and metabolic effects of fluid resuscitation in Vietnamese adults with severe Falciparum malaria. PLoS One. 2011;6(10):e25523.
Available:https://doi.org/10.1371/journal.pone.0025523
Bhutani A, Kaushik RM, Kaushik R. A study on multi-organ dysfunction syndrome in malaria using sequential organ failure assessment score. Trop Parasitol. 2020;10(2):86-94.
Available:https://doi.org/10.4103/tp.TP_12_19
Agudelo Higuita NI, White BP, Franco-Paredes C, McGhee MA. An update on prevention of malaria in travelers. Ther Adv Infect Dis. 2021;30(8):204993612110 40690.
Available:https://doi.org/10.1177/20499361211040690
Gallay J, Mosha D, Lutahakana E. Appropriateness of malaria diagnosis and treatment for fever episodes according to patient history and anti-malarial blood measurement: A cross-sectional survey from Tanzania. Malar J. 2018;17:209.
Available:https://doi.org/10.1186/s12936-018-2357-7
Tobón A. Signos de peligro en el paciente con malaria [Danger signs in the malaria patient]. Biomedica, Spanish. 2009;29(2):320-9.
PMID: 20128356
World Health Organization. Giemsa staining of malaria blood films; 2016.
Available:https://apps.who.int/iris/bitstream/handle/10665/340462/WHO-HTM-GMP-MM-SOP-2016.07a-eng.pdf?sequence=1
Al Farsi F, Chandwani J, Mahdi AS, Petersen E. Severe imported malaria in an intensive care unit: A case series. ID Cases. 2019;17:e00544.
Available:https://doi.org/10.1016/j.idcr.2019.e00544.
Pasvol G. The treatment of complicated and severe malaria, British Medical Bulletin, 2005;75-76(1):29–47.
Available:https://doi.org/10.1093/bmb/ldh059
Li I, Cheung L. How not to miss a case of malaria in emergency department in malaria non-endemic areas? Practical approach & experiences in Hong Kong. Open Journal of Emergency Medicine. 2016;4:93-109.
Available:https://doi.org/10.4236/ojem.2016.44012.
Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, et al. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLoS Med. 2020;17(10):e1003359.
Available:https://doi.org/10.1371/journal.pmed.1003359
Martínez-Carrillo BE, Elina B, Rillo AG, Castillo-Cardiel JA, García-Arqueta I, Palacios-Jaimes ML. Natural and social history of the health-disease process as an epistemological model for medical education (Part 2). IOSR Journal of Research & Method in Education (IOSR-JRME). 2021;11(1):56-65.
Available:https://doi.org/10.9790/7388-1101035665
Babiker A, El Husseini M, Al Nemri A, Al Frayh A, Al Juryyan N, Faki MO, Assiri A, Al Saadi M, Shaikh F, Al Zamil F. Health care professional development: Working as a team to improve patient care. Sudan J Paediatr. 2014;14(2):9-16.
Sanders JJ, Curtis JR, Tulsky JA. Achieving goal-concordant care: A conceptual model and approach to measuring serious illness communication and its impact. Journal of Palliative Medicine. 2018;21:S2, S-17-S-27.
Available:https://doi.org/10.1089/jpm.2017.0459
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