Plasmodium knowlesi: der fünfte Malariaparasit – Epidemiologie, Diagnose und Therapie

Plasmodium knowlesi hat sich seit den 1990er Jahren als fünfte humanpathogene Plasmodienart in Südostasien etabliert. Der Parasit kam ursprünglich nur in Affenarten vor. Durch ökologische Veränderungen im Lebensraum der Affen wird er nun auch relativ leicht auf Menschen übertragen und führt zu schweren, potenziell tödlichen Malariafällen. Der Parasit ist mikroskopisch mit P. malaria identisch. Deshalb ist eine PCR zur Bestätigung der Diagnose erforderlich. Die Therapie erfolgt weitgehend unkompliziert mit gängigen Malariamitteln. Haben Rückkehrer aus Südostasien Fieber, ist differenzialdiagnostisch auch immer P. knowlesi zu erwägen. Sollte sich ein vom Affen unabhängiger Übertragungszyklus Mensch-Mücke-Mensch etablieren, muss mit einer erheblichen Ausbreitung in Asien gerechnet werden.

Summary

Human malaria has been known to be caused by 4 different Plasmodium species. Since the 1990s, hundreds of cases in Southeast Asia have been caused by a fifth Plasmodium species, P. knowlesi. This parasite usually infects monkeys. Ecological changes in the habitat of the hosts have brought the parasite into close contact with humans and transmission has been established. The parasite has the capacity to cause severe and potentially lethal malaria. Diagnosis has to be confirmed by PCR, since conventional microscopy cannot distinguish between P. knowlesi and P. malariae. Therapy is possible with any established antimalarial treatment. The diagnosis should be considered in any febrile patient returning from Southeast Asia. Although currently confined to closed ranges in tropical rain forests in Southeast Asia, the parasite has the potential to spread widely once a man-mosquito-man cycle is established.

Key words

malaria - Plasmodium knowlesi - febrile patient - Southeast Asia

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