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Background   Plasmodium ovale  is one of the causative agents of human malaria.  Plasmodium ovale  infection has long been thought to be non-fatal. Due to its lower morbidity,  P. ovale  receives little attention in malaria research.    Methods  Two Malaysians went to Nigeria for two weeks. After returning to Malaysia, they fell sick and were admitted to different hospitals.  Plasmodium ovale  parasites were identified from blood smears of these patients. The species identification was further confirmed with nested PCR. One of them was successfully treated with no incident of relapse within 12-month medical follow-up. The other patient came down with malaria-induced respiratory complication during the course of treatment. Although parasites were cleared off the circulation, the patient’s condition worsened. He succumbed to multiple complications including acute respiratory distress syndrome and acute renal failure.    Results  Sequencing of the malaria parasite DNA from both cases, followed by multiple sequence alignment and phylogenetic tree construction suggested that the causative agent for both malaria cases was  P. ovale curtisi .    Discussion  In this report, the differences between both cases were discussed, and the potential capability of  P. ovale  in causing severe complications and death as seen in this case report was highlighted.    Conclusion   Plasmodium ovale  is potentially capable of causing severe complications, if not death. Complete travel and clinical history of malaria patient are vital for successful diagnoses and treatment. Monitoring of respiratory and renal function of malaria patients, regardless of the species of malaria parasites involved is crucial during the course of hospital admission.

Acute respiratory distress syndrome and acute renal failure from Plasmodium ovale infection with fatal outcome