1/103. Imported tertian malaria resistant to primaquine. In plasmodium vivax and plasmodium ovale malaria, some of the liver stage parasites remain dormant. The activation of these dormant forms (called hypnozoite) can give rise to relapse weeks, months or years after the initial infection. To prevent relapses, a course of primaquine may be given as terminal prophylaxis to patients. Different strains of plasmodium vivax vary in their sensitivity to primaquine and, recently, cases of relapse of plasmodium vivax after this standard primaquine therapy were reported from various countries. We reported a case of primaquine resistant malaria which initially was thought to be relapsed caused by loss of terminal prophylaxis. ( info) |
2/103. Case studies in international travelers. family physicians should be alert for unusual diseases in patients who are returning from foreign travel. malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of Plasmodium organisms on a specially prepared blood film. Travelers can also acquire amebic infections, which may cause dysentery or, in some instances, liver abscess. amebiasis is diagnosed by finding entamoeba histolytica cysts or trophozoites in the stool. Invasive amebic infections are generally treated with metronidazole followed by iodoquinol or paromomycin. Cutaneous larva migrans is acquired by skin contact with hookworm larvae in the soil. The infection is characterized by the development of itchy papules followed by serpiginous or linear streaks. Cutaneous larva migrans is treated with invermectin or albendazole. Case studies are presented. ( info) |
| Recently fully automated methods for enumerating reticulocytes have become available as an integral function in routine haematology analysers. In such methods, all intraerythrocytic nucleic acid is stained and can be regarded as representing reticulocytes. It has previously been shown that Howell-Jolly bodies may be counted as reticulocytes in automated flow cytometric methods. In the present paper, data from two patients are described indicating that severe malaria infection may lead to falsely increased reticulocyte counts, at least in the CELL-DYN(R) 4000 haematology analyser. In this instrument, the intraerythrocytic nuclear material of the parasites will be stained and counted as reticulocytes. This phenomenon appears to be independent of the type of Plasmodium infection. Clinical haematology laboratories should be aware of this potential source of pseudo-reticulocytosis. ( info) |
| In india, malaria is endemic and commonly caused by plasmodium vivax and P. falciparum. thrombocytopenia is a common finding in falciparum infection but is rare in P. vivax infection. We report profound thrombocytopenia in a 43-year-old female patient due to P. vivax infection. The platelet count was as low as 5 x 10(9)/liter, such severe thrombocytopenia has never been reported in vivax malaria. ( info) |
| We report a case of posttransplant malaria in which the patient developed progressive thrombocytopenia after receiving living related donor kidney transplantation. The donor, who flew in from sri lanka for the procedure, had suffered from malaria 18 months earlier. malaria should be suspected in transplant patients receiving organs from donors originating from countries with a high prevalence of malaria. ( info) |
| Severe anemia requiring blood transfusion may complicate falciparum malaria, but is rare in nonfalciparum malaria. We present a case of a young man with high fever, severe hemolytic anemia, and a blood film containing massive co-infection with plasmodium vivax and with borrelia. The possible importance of the co-infection on the magnitude of hemolysis will be discussed. ( info) |
7/103. Congenital malaria: a case report. Congenital malaria is an uncommon disease even in endemic areas. A 19-day-old female infant with congenital malaria is presented. The mother of the patient was diagnosed to have malaria at the seventh month of gestation and was treated with chloroquine orally for three days. No malarial prophylaxis was given. The infant developed fever, hyperbilirubinemia, anemia and hepatosplenomegaly postnatally. Thin blood smears revealed many plasmodium vivax parasites. She was treated with oral chloroquine for three days. We emphasize the importance of adequate antenatal medical therapy and prophylaxis during pregnancy. ( info) |
| A 41-year-old woman was admitted with fever, splenomegaly and pancytopenia. High serum ferritin, hypertriglyceridaemia and bone marrow haemophagocytosis were consistent with a haemophagocytic syndrome. trophozoites and gametocytes of plasmodium vivax were identified on blood smear. Rapid recovery was observed after treatment with oral chloroquine. ( info) |
9/103. Infectious disease challenges in immigrants from tropical countries. BACKGROUND: In today's mobile society, international travel and immigration are becoming increasingly more common. This poses an additional challenge to the clinician to expand the differential diagnosis to include diseases endemic to the area of travel. observation: We present a case of malaria and tuberculosis in a 16-year-old African male immigrant. He had several encounters with the health care system for complaints of nonspecific symptoms for which he was treated with antibiotics without follow-up. CONCLUSION: Clinicians should take a complete history and expand their differential diagnosis to include diseases endemic to the country of origin and/or travel when treating an international patient. This not only will allow prompt treatment of the patient's condition but also will address public health concerns. ( info) |
10/103. Probable locally acquired mosquito-transmitted plasmodium vivax infection--Suffolk County, new york, 1999. In the united states, malaria transmission was eliminated in the 1940s, and malaria eradication was certified in 1970 (1). Since then, 60 small localized outbreaks of probable mosquito-transmitted malaria have been reported to CDC (2-6). Before 1995, the number of imported malaria cases reported to the Suffolk County (new york) Department of health services ranged from zero to eight per year. Since 1995, seven to 17 cases per year have been reported. In all of these cases, a history of residing in or traveling to an area with endemic malaria outside the united states was confirmed. This report describes the investigation of two cases of plasmodium vivax malaria that occurred in Suffolk County in August 1999; the patients had no history of travel outside of the united states. ( info) |