31/292. Molecular characterisation of airport malaria: four cases in france during summer 1999. Four airport malaria cases have been observed in the vicinity of the Roissy-Charles-de-Gaulle International Airport, paris, france. These cases were geographically very close to each other and clustered in a short period of time during the summer of 1999. The phenotype and genotype of the plasmodium falciparum isolates obtained from these patients were determined in order to know whether a single mosquito could have infected more than one subject. The genomic characterisation of isolates was performed using the polymorphic markers merozoite surface protein 1 (Msp 1) and merozoite surface protein 2 (Msp 2) genes, the kappa and omega repeats domains of cg2 and the dihydrofolate reductase (DHFR) genotypes. Results showed identical genotypes for isolates 1, 2 and 4 whereas the genotype of isolate 3 differed at one locus. The molecular analysis was consistent with the hypothesis that all patients could have been bitten by the same mosquito and that patient 3, may have received a different clone and an additional species. in vitro susceptibility data did not confirm or rule out this hypothesis because isolates had the same profile of susceptibility to the tested drugs. ( info) |
32/292. Congenital malaria in 8 hours old newborn: case report. This report, presents a case of congenital malaria in an 8-hour-old female neonate. She responded well to oral chloroquine at a dose of 25 mg/kg in divided doses over a period of three days and was discharged home for follow-up, 24 hours after completion of the course of chloroquine. This case emphasized the need for routine screening for malaria in sick newborn infants in malaria endemic regions. This is particularly important in situations where clear evidence of sepsis cannot be established, either from history or physical examination of the sick newborn. Malaria and sepsis have similar clinical features in newborn infants. ( info) |
33/292. Malaria surveillance--united states, 1993. PROBLEM/CONDITION: Malaria is caused by infection with one of four species of Plasmodium (P. falciparum, P. vivax, P. ovale, and P. malariae), which are transmitted by the bite of an infective female anopheles sp. mosquito. Most malaria cases in the united states occur among persons who have traveled to areas (i.e., other countries) in which disease transmission is ongoing. However, cases are transmitted occasionally through exposure to infected blood products, by congenital transmission, or by local mosquito-borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations. REPORTING PERIOD COVERED: Cases with onset of illness during 1993. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood smear are reported to local and/or state health departments by health-care providers and/or laboratories. Case investigations are conducted by local and/or state health departments, and the reports are transmitted to CDC. RESULTS: CDC received reports of 1,275 cases of malaria in persons in the united states and its territories who had onset of symptoms during 1993; this number represented a 40% increase over the 910 malaria cases reported for 1992. P. vivax, P. falciparum, P. ovale, and P. malariae were identified in 52%, 36%, 4%, and 3% of cases, respectively. The species was not determined in the remaining 5% of cases. The 278 malaria cases in U.S. military personnel represented the largest number of such cases since 1972; 234 of these cases were diagnosed in persons returning from deployment in somalia during Operation Restore hope. In new york city, the number of reported cases increased from one in 1992 to 130 in 1993. The number of malaria cases acquired in africa by U.S. civilians increased by 45% from 1992; of these, 34% had been acquired in nigeria. The 45% increase primarily reflected cases reported by new york city. Of U.S. civilians who acquired malaria during travel, 75% had not used a chemoprophylactic regimen recommended by CDC for the area in which they had traveled. Eleven cases of malaria had been acquired in the united states: of these cases, five were congenital; three were induced; and three were cryptic, including two cases that were probably locally acquired mosquito-borne infections. Eight deaths were associated with malarial infection. INTERPRETATION: The increase in the reported number of malaria cases was attributed to a) the number of infections acquired during military deployment in somalia and b) complete reporting for the first time of cases from new york city. ACTIONS TAKEN: Investigations were conducted to collect detailed information concerning the eight fatal cases and the 11 cases acquired in the united states. Malaria prevention guidelines were updated and disseminated to health-care providers. persons who have a fever or influenza-like illness after returning from a malarious area should seek medical care, regardless of whether they took antimalarial chemoprophylaxis during their stay. The medical evaluation should include a blood smear examination for malaria. Malaria can be fatal if not diagnosed and treated rapidly. Recommendations concerning prevention and treatment of malaria can be obtained from CDC. ( info) |
34/292. pancytopenia resulting from hemophagocytosis in malaria. pancytopenia in an acutely ill child is commonly a result of bone marrow suppression. Rarely pancytopenia is a manifestation of inappropriate macrophage activation associated with hemophagocytosis. Viral infections account for most cases of secondary hemophagocytosis. We report a case of malaria-associated hemophagocytosis in a child from an endemic area. Systemic parasitic infections should be included in the differential diagnosis of pancytopenia and infection-associated hemophagocytosis. In this rare subgroup of hemophagocytosis, malaria caused by plasmodium falciparum is the most common parasitic infection ( info) |
| We describe a case of locally acquired plasmodium ovale malaria in spain. The patient was a Spanish woman who had never traveled out of spain and had no other risk factors for malaria. Because patients with malaria may never have visited endemic areas, occasional transmission of malaria to European hosts is a diagnostic and clinical challenge. ( info) |
36/292. Postmalaria neurological syndrome: two cases from the gambia. We describe 2 patients with severe plasmodium falciparum malaria whose convalescence was complicated by fever, with acute confusion and acalculia in one patient and a triad of myoclonus, tremor, and dysphasia in the other. Inflammatory changes were found in cerebrospinal fluid samples. Postmalaria neurological syndrome was diagnosed in each patient, and a therapeutic response to oral corticosteroids was seen in the second patient. ( info) |
| O'Brien's actinic granuloma is clinically characterized by annular papules and plaques on sun-exposed areas of skin. These lesions often occur insidiously on a background of severe solar elastosis; however, an acute variant following sunburn has been reported in the literature. We present two cases of acute actinic granuloma precipitated by episodes of sunburn occurring on a background of prolonged doxycycline phototoxicity. Biopsies from both patients showed a histiocytic infiltrate with multinucleate giant cells engulfing elastotic material, with a reduction of elastin towards the centre of the papule. Marked resolution of the lesions was noted after 8 weeks of treatment with betamethasone dipropionate 0.05% ointment in optimized vehicle together with adequate photoprotection in the form of broad-spectrum sunscreens. ( info) |
38/292. Airport malaria: report of a case and a brief review of the literature. We report a case of plasmodium vivax malaria in a patient who had not visited an endemic area. The ways in which malaria can be transmitted in non-endemic areas are discussed. By the elimination of other possibilities, the diagnosis of airport malaria was made. Airport malaria is a rare and often initially overlooked diagnosis. Since 1969, some 89 cases of airport malaria have been reported. ( info) |
| A community-based rainy-season malaria prevalence survey was conducted in Bobonaro district, in recently independent east timor, in 2001. Although the survey was primarily aimed at defining the prevalence of plasmodium falciparum and P. vivax, six individuals with P. malariae infection were identified (prevalence 0.57%). We believe these are the first reported cases of P. malariae from the island of Timor. ( info) |
40/292. The diagnostic dilemma of intraoperative hyperpyrexia in a malaria endemic area. malignant hyperthermia (MH) is a serious and feared complication of general anaesthesia. The diagnosis of MH may pose a diagnostic dilemma, as its two most common signs tachycardia and hyperthermia are also common features of infections, transfusion and drug reactions. We report three cases of hyperthermia occurring during anaesthesia posing diagnostic dilemma in which two of the cases appear to be due to malaria. It is therefore suggested that all patients undergoing anaesthesia in a malaria endemic area should be investigated and treated for malaria if indicated preoperatively even when asymptomatic to prevent such diagnostic confusion. ( info) |