Abdominal Computed Tomography Scan: A Useful Diagnosis Tool for Early and Delayed Splenic Complications in Malaria

We read with great interest the study on the abdominal computed tomography (CT) scan during acute vivax malaria in South Korea by Kim and others. 1 In our recent analysis of 55 cases of pathological rupture on the spleen in malaria, 2 we found that 23 (42%) were caused by Plasmodium vivax . We therefore agree with Kim and others that infection with P. vivax —less prevalent worldwide than Plasmodium falciparum —likely carry a higher risk of splenic complications than infection with P. falciparum . Acute splenic enlargement, which is as frequent in P. vivax as in P. falciparum infection despite lower mean parasitemia in the former, 3 is likely to be a major determinant of both splenic infarction and splenic rupture in malaria . Splenic enlargement during lethal falciparum malaria likely results from splenic congestion with surface-altered and mechanically altered red blood cells (either infected or uninfected), and with migration or local multiplication of white blood cells. 4– 6 Because patients with vivax malaria rarely die, post-mortem data on the spleen in this context are very limited. 7