Kasaragod District of Kerala state has never reported cases of plasmodium malariae. During September 1999-March 2000 a total of 52 slides were reported as positive for P. vivax, P. falciparum and mixed infection. The expert team cross-checked these positive slides and three were found positive for P. malariae which were reported as P. vivax. All these had similar clinical features and were either imported cases from endemic areas or local population who visited endemic areas or by persons who came in as construction workers. ( info) |
22/292. Malaria deaths following inappropriate malaria chemoprophylaxis--united states, 2001. During January-March 2001, two U.S. citizens died from malaria after taking chloroquine alone or with proguanil for malaria chemoprophylaxis in countries with known chloroquine-resistant plasmodium falciparum malaria. chloroquine-containing chemoprophylaxis regimens are not recommended by CDC for persons traveling to areas with known chloroquine-resistant P. falciparum. This report summarizes the investigation of the two cases and underscores the need for clinicians and travelers to know the recommended options for malaria chemoprophylaxis when traveling to locations with chloroquine-resistant malaria. ( info) |
23/292. Parasitic procrastination: late-presenting ovale malaria and schistosomiasis. A 29-year-old woman with ovale malaria (most likely contracted, together with asymptomatic schistosomiasis, in East africa two years previously) had fever, nausea and confusion, jaundice, anaemia, thrombocytopenia, hyponatraemia and hypokalaemia. She was initially diagnosed with and treated for blood-smear-positive vivax malaria. Because of the unusual clinical presentation, blood was analysed by a malaria species-specific nested polymerase chain reaction (PCR) assay which identified plasmodium ovale as the only infecting species. This case illustrates (i) that a detailed travel history remains a vital part of clinical assessment, (ii) ovale malaria can have an exceptionally long incubation period and features of a moderately severe acute infection, and (iii) PCR assay may prove a valuable adjunct to blood film examination in the diagnosis and speciation of malaria. ( info) |
24/292. Case report: Retinopathy after malaria prophylaxis with chloroquine. chloroquine retinopathy (CR) is a major complication of long-term malaria prophylaxis (LTMP) causing permanent visual dysfunction and occasionally blindness. After an extensive review of the published accounts of CR, we concluded that the risk of retinopathy in subjects receiving LTMP is limited to a cumulative dose that does not exceed 140 g. We present a case of CR that occurred after 8 years of malaria prophylaxis with chloroquine at a cumulative dose of 125 g. Because a threshold dose of chloroquine for retinal toxicity has not been established, careful, ongoing screening is required, especially as the cumulative dose increases. ( info) |
25/292. Malaria surveillance--united states, 1998. PROBLEM/CONDITION: Human malaria is caused by one or more of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). The protozoa are transmitted by the bite of an infective female anopheles species mosquito. The majority of malaria infections in the united states occur among persons who have traveled to areas with endemic transmission. Cases occasionally occur that are acquired through exposure to infected blood products, by congenital transmission, or by local mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. REPORTING PERIOD: Cases with an onset of symptoms during 1998. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are reported to local and state health departments by health-care providers and laboratory staff members. Case investigations are conducted by local and state health departments, and reports are sent to CDC through the National Malaria Surveillance System (NMSS). This report uses NMSS data. RESULTS: CDC received reports of 1,227 cases of malaria with onsets of symptoms in 1998, among persons in the united states and its territories. This number represents a decrease of 20.5% from the 1,544 cases reported during 1997. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 42.8%, 37.8%, 3.5%, and 2.1% of cases, respectively. More than one species was present in seven patients (0.6% of total). The infecting species was not determined in 162 (13.2%) cases. Compared with reported cases in 1997, reported malaria cases acquired in africa increased by 1.3% (n = 706); those acquired in asia decreased by 52.1% (n = 239); and those acquired in the americas decreased by 6.5% (n = 229). Of 636 U.S. civilians who acquired malaria abroad, 126 (19.8%) reportedly had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Five persons became infected in the united states. One case was congenitally acquired; one was acquired by blood transfusion; and three were isolated cases that could not be epidemiologically linked to another case. Four deaths were attributed to malaria. INTERPRETATION: The 20.5% decrease in malaria cases during 1998 compared with 1997 resulted primarily from decreases in P. vivax cases acquired in asia among non-U.S. civilians. This decrease could have resulted from local changes in disease transmission, decreased immigration from the region, decreased travel to the region, incomplete reporting from state and local health departments, or increased use of effective antimalarial chemoprophylaxis. In a majority of reported cases, U.S. civilians who acquired infection abroad had not taken an appropriate chemoprophylaxis regimen for the country where they acquired malaria. public health ACTIONS TAKEN: Additional information was obtained from state and local health departments and clinics concerning the four fatal cases and the five infections acquired in the united states. persons traveling to a malarious area should take a recommended chemoprophylaxis regimen and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and subsequently develops fever or influenza-like symptoms should seek medical care immediately; the investigation should include a blood smear for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Current recommendations concerning prevention and treatment of malaria can be obtained from CDC. ( info) |
Congenitally acquired malaria is rare in the united states; < or = 10 cases are reported each year. Congenital infection with plasmodium malariae is particularly uncommon because distribution of this parasite is focal and sparse in areas where P. falciparum is endemic. The last case of congenital P. malariae infection in the united states was reported in 1992. This report describes the investigation of a case of P. malariae in an infant with no travel history outside of the united states and suggests that health-care providers suspect malaria when treating a neonate or young infant with fever if the mother has traveled or lived in a malarious area. ( info) |
27/292. Ophthalmologic findings in malaria. During the Vietnamese conflict, malaria in epidemic proportions constituted a serious health hazard to our forces. Although rarely encountered worldwide, Falciparum malaria proved to be an extremely lethal and dangerous complicating factor. Ophthalmologic complications of malaria are discussed and particular attention is placed on Falciparum malaria with the report of a case in detail and the presentation of unusual fundus findings. ( info) |
28/292. Hypersensitivity syndrome associated with dapsone/pyrimethamine (Maloprim) antimalaria chemoprophylaxis. BACKGROUND: dapsone 100 mg/pyrimethamine 12.5 mg (Maloprim; Beacons Chemicals Pte Ltd, singapore) is routinely prescribed for antimalarial chemoprophylaxis in military servicemen in singapore who are not glucose-6-phosphate dehydrogenase-deficient. methods: We report a series of three male National Servicemen with hypersensitivity syndrome from Maloprim. RESULTS: The three patients were diagnosed with hypersensitivity syndrome based on the presence of features of a drug hypersensitivity syndrome including fever, lymphadenopathy, maculopapular exanthema, hepatitis, and definite exposure to weekly Maloprim alone. A mild Coombs positive hemolytic anemia was also observed in one patient. All the clinical, hematologic, and biochemical derangements normalized within 3 months of tapering regimens of moderate-dose prednisolone. CONCLUSIONS: Drug hypersensitivity syndromes can occur even on low-dose, weekly drug regimens. Hypersensitivity syndrome from weekly Maloprim is potentially reversible when recognized and treated early. ( info) |
29/292. Artefactually-normal automated platelet counts due to malaria-infected RBC. Protein aggregates, red cell or white cell fragments are known to interfere with platelet counts in automated blood analysers, both by aperture impedance and optical technologies. When a falsely high value is suspected, interference by pseudo-platelet particles can be confirmed by systematic examination of stained blood films. The method that best avoids these sources of interference is the reference, immunological platelet count. We describe a case of treated malaria with a false normal platelet count. The blood smear revealed small red cells, infected by trophozoites of plasmodium falciparum, that interfered with the platelet count. The Cell Dyn 4000 shows different patterns of interference by infected red cells in its impedance and optical counts, and thrombocytopenia was suspected immediately. This was confirmed by a phase-contrast microscopic platelet count. ( info) |
30/292. Coronary bypass surgery in patient with malaria. A 65-year-old man with unstable angina pectoris developed malaria prior to coronary artery bypass grafting. After 3 weeks on antimalarial therapy, left internal mammary artery-to-left anterior descending artery anastomosis was performed on the beating heart to avoid the effects of cardiopulmonary bypass. There was no complication in the early postoperative period. ( info) |