A Case of Septic Shock in Malaria Tertiana Relapse
Abstract
Malaria is a vector-borne parasitic disease that until today continous as a burden global health system, especially in tropical and subtropical regions. Plasmodium vivax was one of the five species infecting humans. It poses a unique challenge due to its ability to form dormant hypnozoites in the liver, which can reactivate and cause relapses long after initial infection. Clinical diagnosis is complicated by typically low parasitemia, non-specific symptoms and limitations in routine laboratory techniques. This case report presents a 27-year-old male who developed malaria caused by P. vivax after returning from Papua, an endemic area in Indonesia. The patient initially received dihydroartemisinin-piperaquine (DHP) and primaquine therapy in accordance with national guidelines, resulting in clinical improvement and parasitological clearance. However, 28 days after completing therapy, he returned with recurrent fever and laboratory confirmation of P. vivax with a parasitemia index of 1%, indicating a relapse. The patient was subsequently treated with oral quinine and responded favorably. This case underscores the complexity of managing malaria tertiana, especially in the absence of definitive biomarkers to differentiate relapse from reinfection. Diagnostic difficulties are compounded by the inability to routinely culture P. vivax in vitro. Clinicians must remain vigilant in assessing travel history, treatment adherence, and parasitemia recurrence timelines.
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