1
|
Gimenez AM, Marques RF, Regiart M, Bargieri DY. Diagnostic Methods for Non-Falciparum Malaria. Front Cell Infect Microbiol 2021; 11:681063. [PMID: 34222049 PMCID: PMC8248680 DOI: 10.3389/fcimb.2021.681063] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria is a serious public health problem that affects mostly the poorest countries in the world, killing more than 400,000 people per year, mainly children under 5 years old. Among the control and prevention strategies, the differential diagnosis of the Plasmodium-infecting species is an important factor for selecting a treatment and, consequently, for preventing the spread of the disease. One of the main difficulties for the detection of a specific Plasmodium sp is that most of the existing methods for malaria diagnosis focus on detecting P. falciparum. Thus, in many cases, the diagnostic methods neglect the other non-falciparum species and underestimate their prevalence and severity. Traditional methods for diagnosing malaria may present low specificity or sensitivity to non-falciparum spp. Therefore, there is high demand for new alternative methods able to differentiate Plasmodium species in a faster, cheaper and easier manner to execute. This review details the classical procedures and new perspectives of diagnostic methods for malaria non-falciparum differential detection and the possibilities of their application in different circumstances.
Collapse
Affiliation(s)
- Alba Marina Gimenez
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodolfo F. Marques
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Matías Regiart
- Department of Fundamental Chemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | - Daniel Youssef Bargieri
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Yeruva SLH, Sinha A, Sarraf-Yazdy M, Gajjala J. Imported Malaria over Fifteen Years in an Inner City Teaching Hospital of Washington DC. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:261-4. [PMID: 27417079 PMCID: PMC4977779 DOI: 10.3347/kjp.2016.54.3.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/24/2016] [Accepted: 05/02/2016] [Indexed: 11/29/2022]
Abstract
As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment.
Collapse
Affiliation(s)
| | - Archana Sinha
- Department of Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Mariam Sarraf-Yazdy
- Department of Internal Medicine, Howard University Hospital, Washington DC, USA
| | - Jhansi Gajjala
- Department of Infectious Disease, Howard University Hospital, Washington DC, USA
| |
Collapse
|
3
|
Abstract
OBJECTIVES Despite the availability of effective antimalarial prophylaxis, imported adult and pediatric malaria occurs in the United States, and this can pose diagnostic issues. We examined the clinical characteristics and diagnostic challenges of imported malaria requiring adult or pediatric inpatient admission at Montefiore Medical Center in the Bronx which provides care for a large population of immigrants from malaria endemic areas. STUDY DESIGN We conducted a retrospective single center review of patients admitted with a diagnosis of malaria at Montefiore Medical Center from 2005 through 2012. We extracted historical, clinical, and laboratory values from the electronic medical record and patient charts. RESULTS We identified 95 patients who were diagnosed and hospitalized with malaria from 2005 to 2012, 33 (35%) of them were children and 17 (18%) were with severe malaria. Most patients contracted malaria while visiting friends and relatives in West Africa. Only 38% of travelers took prophylaxis, and fewer than half reported taking it as prescribed. Misdiagnosis by emergency room or primary care doctors was observed in almost one quarter of all of the patients. Misdiagnosis occurred significantly more frequently in children (43%) compared to adults (13%) (P = 0.002). Pediatric patients were more likely to present with abdominal pain (42% vs. 15%; P = 0.005). CONCLUSIONS Pediatric patients admitted for imported malaria at Montefiore Medical Center had a higher rate of misdiagnosis and presented with more gastrointestinal symptoms than hospitalized adults. By describing the clinical characteristics of patients with imported malaria, we hope to improve diagnostic accuracy by health care workers and raise awareness that friends and relatives may require more intensive pretravel counseling.
Collapse
|
4
|
More than interpreters needed: the specialized care of the immigrant pregnant patient. Obstet Gynecol Surv 2015; 69:490-500. [PMID: 25144612 DOI: 10.1097/ogx.0000000000000099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The immigrant pregnant woman faces unique challenges. This article provides an overview of these challenges and interventions to maximize health outcomes for the immigrant pregnant woman. A patient's immigrant status may impact her social stability and access to health care. Lack of familiarity with western health care, health financing, and the English language can create significant barriers. In addition, providers must remember to evaluate the immigrant pregnant woman for underlying health conditions that may be present including infectious diseases endemic to their country of origin and chronic diseases or cervical center as yet unidentified because of lack of previous health care screening. Female genital modification found in some immigrant populations can be associated with poorer obstetric outcomes and should be documented and addressed. Finally, some immigrant populations have a high incidence of past severe trauma and need additional psychiatric evaluation and support.
Collapse
|
5
|
Lüthi B, Schlagenhauf P. Risk factors associated with malaria deaths in travellers: A literature review. Travel Med Infect Dis 2015; 13:48-60. [DOI: 10.1016/j.tmaid.2014.04.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/17/2014] [Accepted: 04/23/2014] [Indexed: 11/30/2022]
|
6
|
Nilles EJ, Arguin PM. Imported malaria: an update. Am J Emerg Med 2011; 30:972-80. [PMID: 21908138 DOI: 10.1016/j.ajem.2011.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 11/29/2022] Open
Abstract
Evidence suggests that imported malaria is a diagnostic challenge with initial misdiagnosis rates of 40% or greater. Given that prompt diagnosis and appropriate treatment are the only intervention proven to prevent progression to severe malaria and death, these figures are concerning. The purpose of this clinical review is to provide the most up-to-date and practical information on the diagnosis and treatment of imported malaria for the emergency health care provider. We highlight common pitfalls, errors, and mistakes in arriving at the correct diagnosis. We also emphasize the 3 key aspects to avoid progression to severe disease: rapid diagnosis, prompt initiation of treatment, and appropriate choice of antimalarial treatment.
Collapse
Affiliation(s)
- Eric J Nilles
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | | |
Collapse
|
7
|
Pediatric travelers visiting friends and relatives (VFR) abroad: illnesses, barriers and pre-travel recommendations. Travel Med Infect Dis 2010; 9:192-203. [PMID: 21074496 DOI: 10.1016/j.tmaid.2010.09.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 11/21/2022]
Abstract
Global mobility has shown a steady rise in recent years, with increased immigration and international travel. The VFR traveler is a traveler whose primary purpose of travel is to visit friends and relatives (VFR), where there is a gradient of risk between home and destination. Children are more likely to be VFR travelers than adults. Pediatric VFR travelers have higher risks for certain infectious travel-related illnesses and face multiple barriers in receiving comprehensive pre-travel care. This review focuses on the current state of knowledge of the pediatric VFR traveler, including epidemiological risks, barriers to adequate pre-travel services, and specific recommendations for disease prevention.
Collapse
|
8
|
Mathai S, Bishburg E, Slim J, Nalmas S. Severe Malaria in Immigrant Population: A Retrospective Review. J Immigr Minor Health 2009; 12:921-4. [DOI: 10.1007/s10903-009-9256-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
Abstract
Hundreds of millions of people suffer from malaria, and more than a million children die of malaria each year. Malaria typically presents with fever and headache, but the presentation often is nonspecific. The diagnosis should be based on blood tests, and thick and thin smears are the standard means of identifying parasites. In some areas, chloroquine still is effective as treatment, but other medications are needed in most parts of the world. Patients with severe disease (altered consciousness, marked anemia, and/or respiratory distress) should begin therapy parenterally. Control measures depend on the use of insecticide-treated bednets, early identification and treatment of symptomatic individuals, and intermittent preventive therapy. Progress continues toward the development of a useful vaccine.
Collapse
Affiliation(s)
- Andrea P Summer
- Department of Pediatrics, Medical University of South Carolina, Charleston, USA
| | | | | |
Collapse
|
10
|
Vicas AE, Albrecht H, Lennox JL, del Rio C. Imported malaria at an inner-city hospital in the United States. Am J Med Sci 2005; 329:6-12. [PMID: 15654173 DOI: 10.1097/00000441-200501000-00002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 1000 cases of malaria are reported to the Centers for Disease Control and Prevention each year among travelers or immigrants. METHODS Retrospective study of patients with malaria seen at Grady Memorial Hospital in Atlanta, Georgia, between October 1988 and September 2000. RESULTS One hundred twenty-six cases of malaria were diagnosed at Grady Memorial Hospital during the study period. Fourteen patients had seen a physician prior to coming to Grady Memorial Hospital, and in 71% the diagnosis was missed. Half had recently immigrated and half recently traveled to an endemic area, yet only 22% of travelers took prophylaxis. Plasmodium falciparum was the most commonly identified species (52.4%), followed by Plasmodium vivax (23.9%). Seventy-two patients (57.1%) required hospitalization. Presenting symptoms included fever (94%), chills (56%), nausea/vomiting (38%), headache (26%), and abdominal pain (26%). Most patients were diagnosed correctly on the day of admission (79%). Twelve patients (16.7%) had severe malaria, and their complications included severe anemia (9.7%), acute renal failure (4.2%), bleeding and/or disseminated intravascular coagulation (4.2%), shock (2.8%), seizures (2.8%), and hypoglycemia (2.8%). One patient died, and two pregnant women had premature deliveries. Median hospital stay was 3.9 days. One third of the hospitalized patients with P vivax failed to receive primaquine, and in 15% of patients with P falciparum, the treatment was considered to be inappropriate. CONCLUSIONS Although some patients with malaria have a benign course and a good outcome, many patients require hospitalization, and some have severe complications. Increased efforts are needed to educate travelers about the need for prophylaxis.
Collapse
Affiliation(s)
- Aurora E Vicas
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine and the Grady Health System, Atlanta, Georgia 30303, USA
| | | | | | | |
Collapse
|
11
|
McGready R, Ashley EA, Nosten F. Malaria and the pregnant traveller. Travel Med Infect Dis 2004; 2:127-42. [PMID: 17291974 DOI: 10.1016/j.tmaid.2004.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Accepted: 03/16/2004] [Indexed: 10/26/2022]
Abstract
Malaria in pregnancy contributes to significant maternal and foetal mortality and morbidity in women in the tropics. Adverse effects for non-immune travellers are potentially devastating for mother and foetus. Women travellers should always be strongly advised against visiting malarious areas if they are pregnant or intend to get pregnant. Chemoprophylactic and treatment options for pregnant women (or those planning to conceive) are extremely limited and lag behind what can currently be offered to non-pregnant travellers. This is because of spread of multi-resistant strains of P. falciparum. Personal protection from malaria vectors remains essential. Mosquito-net and skin repellents (DEET (20%)) are effective. Diagnosis of malaria in travellers is difficult and is more likely to be missed in pregnant travellers due to lower parasitaemia. Pregnant women can succumb rapidly to severe malaria. Should the returned traveller survive an episode of malaria in pregnancy and go on to deliver, the adverse effects on the infant are potentially irreversible. These risks need to be clearly communicated.
Collapse
Affiliation(s)
- R McGready
- Shoklo Malaria Research Unit, P.O. Box 46, Mae Sot 63110, Thailand; Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; Centre for Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Headington, Oxford, UK
| | | | | |
Collapse
|
12
|
Abstract
Long before the advent of modern chemoprophylaxis drugs, many practitioners successfully prevented the debilitating and fatal outcomes associated with infection by the Plasmodium parasites that cause malaria. Today, with effective insect repellents and several excellent medications available for chemoprophylaxis, there has never been a better array of quality products to prevent mosquito bites and infection and to suppress parasites once in the blood stream; however, there are thousands of imported cases into nonendemic countries and scores of deaths and near-fatal outcomes every year in returning travelers, soldiers, immigrants, and refugees. In this article, the author focuses on practical uses of currently available prevention tools.
Collapse
Affiliation(s)
- Alan J Magill
- Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| |
Collapse
|
13
|
Playford EG, Walker J. Evaluation of the ICT malaria P.f/P.v and the OptiMal rapid diagnostic tests for malaria in febrile returned travellers. J Clin Microbiol 2002; 40:4166-71. [PMID: 12409392 PMCID: PMC139652 DOI: 10.1128/jcm.40.11.4166-4171.2002] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rapid diagnostic tests (RDTs) are less reliant on expert microscopy and have the potential to reduce errors in malaria diagnosis but have not been extensively evaluated in nonimmune persons or in countries where infection is not endemic. We evaluated the ICT P.f/P.v (ICT-Amrad, Sydney, Australia) and OptiMal (Flow Inc., Portland, Oreg.) assays prospectively for the diagnosis of malaria in 158 specimens from 144 febrile returned travellers in Australia by using expert microscopy and PCR as reference standards. Malaria was diagnosed in 93 specimens from 87 patients by expert microscopy, with 3 additional specimens from recently treated patients testing positive for Plasmodium falciparum by PCR. For the diagnosis of asexual-stage P. falciparum malaria, the sensitivity and specificity of the ICT P.f/P.v assay were 97 and 90%, respectively, and those of the OptiMal assay were 85 and 96%, respectively. The ICT P.f/P.v assay missed one infection with a density of 45 parasites/ micro l, whereas the OptiMal assay missed infections up to 2,500/ micro l; below 1,000/ micro l, its sensitivity was only 43%. For the diagnosis of P. vivax malaria, the sensitivity and specificity of the ICT P.f/P.v assay were 44 and 100%, respectively, and those of the OptiMal assay were 80 and 97%, respectively. Both assays missed infections with parasite densities over 5,000/ micro l: up to 10,000/ micro l with the former and 5,300/ micro l with the latter. Despite the high sensitivity of the ICT P.f/P.v assay for P. falciparum malaria, caution is warranted before RDTs are widely adopted for the diagnosis of malaria in nonimmune patients or in countries where malaria is not endemic.
Collapse
Affiliation(s)
- E Geoffrey Playford
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145, Australia.
| | | |
Collapse
|
14
|
White Jr AC, Atmar RL. Infections in Hispanic immigrants. Clin Infect Dis 2002; 34:1627-32. [PMID: 12032899 DOI: 10.1086/340620] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2001] [Revised: 02/25/2002] [Indexed: 11/03/2022] Open
Abstract
Hispanic immigrants are an increasing portion of the United States (US) population. In addition to being at risk for diseases common in the US-born population, Hispanic immigrants also are at risk for infections that do not usually occur in the US-born population. Thus, such diseases as tuberculosis, neurocysticercosis, brucellosis, typhoid fever, malaria, amebiasis, viral exanthems, and hepatitis need to be considered in Hispanics who present with fever or focal lesions. When included in the differential diagnosis, most of these infections can be readily diagnosed and treated with currently available methods.
Collapse
Affiliation(s)
- A Clinton White Jr
- Infectious Disease Section, Department of Medicine, Baylor College of Medicine and Ben Taub General Hospital, Houston, TX, 77030, USA.
| | | |
Collapse
|
15
|
Camus C. Prise en charge thérapeutique d'une forme grave de paludisme à Plasmodium falciparum chez l'adulte. Med Mal Infect 1999. [DOI: 10.1016/s0399-077x(00)87129-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Abstract
The records of 20 children with imported malaria admitted to Kings County Hospital between October 1987 and May 1995 were reviewed. All had a history of recent travel or immigration from a malaria endemic area (West-Africa [16], Central-America [three], and the Caribbean [one]). None of the 10 children with a travel history received appropriate malaria chemoprophylaxis. The most common symptoms and signs were daily fever, chills, and hepatomegaly. Diagnosis was delayed in seven children who were initially felt to have pharyngitis or viral syndrome. Common laboratory findings were anemia and thrombocytopenia. P. falciparum was identified in 70% of the patients. Other species were P. malariae and P. vivax. Complications occurred in six children, hyponatremia in five, seizures in three, and cerebral malaria in one patient. The high incidence of chloroquine-resistant malaria makes chemoprophylaxis difficult in children. The clinical presentation of malaria is nonspecific, and diagnostic delays occur, so a high index of suspicion is needed in children with a travel history.
Collapse
Affiliation(s)
- R M Viani
- Department of Pediatrics, University of California, San Diego, USA
| | | |
Collapse
|
17
|
Abstract
Although the ethnic minority traveler is exposed to the same risks as other travelers, there are special considerations that make them vulnerable to certain diseases. In addition, many ethnic minority travelers are traditionally underserved by the medical community and often travel without the benefit of adequate counseling and immunization. The specific disease entities covered in this article include parasitic diseases (e.g. malaria, trypanosomiasis, intestinal helminths), tuberculosis, and other respiratory diseases, dengue, and sexually transmitted diseases and HIV.
Collapse
Affiliation(s)
- S Shah
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | | | | |
Collapse
|
18
|
Abstract
This review summarizes the epidemiology, clinical course, and diagnosis of malaria. The influence of infection during pregnancy upon maternal and neonatal anemia, stillbirth, preterm labor, low birth weight, and congenital malaria is discussed. Options for treatment and prophylaxis during pregnancy are presented.
Collapse
|
19
|
Abstract
Falciparum malaria is one of the most common infectious illnesses in the world and can progress rapidly to coma and death in the nonimmune patient. The presentation is nonspecific, so blood smears must be made and read quickly. Proper therapy requires taking into account drug resistance, recognizing the signs of severe malaria, and proper treatment for complications. Long-sleeved clothing, bed nets, insecticides, and chemoprophylaxis can help prevent malaria, but the infection must be suspected in any traveler returning from an endemic area. This article reviews epidemiology, diagnosis, treatment, and prevention of falciparum malaria in the temperate zone.
Collapse
Affiliation(s)
- G S Murphy
- Internal Medicine Department, Naval Medical Center San Diego, California, USA
| | | |
Collapse
|
20
|
Kyriacou DN, Spira AM, Talan DA, Mabey DC. Emergency department presentation and misdiagnosis of imported falciparum malaria. Ann Emerg Med 1996; 27:696-9. [PMID: 8644955 DOI: 10.1016/s0196-0644(96)70186-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY OBJECTIVE To review the travel history, clinical presentation, laboratory findings, diagnostic accuracy, management, and outcome of the largest reported series of emergency department patients with imported falciparum malaria in the United States. METHODS This is a retrospective case series at large, inner-city medical center in Los Angeles. Twenty cases of falciparum malaria with initial medical evaluation in the ED were identified from the period 1979 through 1993. RESULTS Fifteen male and 5 female patients were identified, with an age range of 5 to 55 years. All had a recent history (within 2 months) of international travel in regions endemic for malaria. Most (85%) were recent immigrants or expatriates returning from a recent visit to their native country. The most common documented symptoms were fever (100%), chills (65%), vomiting (60%), anorexia (45%), and headache (45%). Tachycardia (85%) and hyperpyrexia (> 39 degrees C) (65%) were the most common presenting signs. Malaria was considered in the ED diagnoses in only 12 cases (60%). The specification of falciparum (malignant) malaria was established in only 2 cases (10%). Hepatitis and gastroenteritis were the most common misdiagnoses. Only four patients received antimalarial medication in the ED. There were no deaths, and complications were limited to thrombocytopenia and anemia. Two patients required transfusion. CONCLUSION Imported falciparum malaria presenting to EDs in the United States is frequently misdiagnosed. Emergency physicians improve their ability to diagnose falciparum malaria by obtaining a thorough travel history on all patients with clinical features suggesting an infectious origin and considering this diagnosis in any patient with a history of travel to or migration from malaria-endemic areas.
Collapse
Affiliation(s)
- D N Kyriacou
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, USA
| | | | | | | |
Collapse
|
21
|
Abstract
Chloroquine-resistant Plasmodium vivax was originally reported in Papua, New Guinea by Reickman in 1989.1 In the same year, in Colombia, South America, Arias and Corredor2 reported relapses of 11 patients suffering from vivax malaria, following a chloroquine-primaquine regimen. Garavelli and Corti3 suggested chloroquine-resistant Plasmodium vivax may be present in Brazil following these therapeutic relapses. Further therapeutic failures in returned travelers from South America were reported by Moore et al (1994).4 We report vivax malaria in a group of expeditioners visiting Guyana who, whereas compliant with antimalarial chemoprophylaxis, developed clinical malaria, adding evidence to the presence of chloroquine-resistant Plasmodium vivax in South America. Raleigh International is a youth development charity that undertakes environmental and community projects around the world. These are usually in remote locations. Nine expeditions in countries such as Chile, Belize, Zimbabwe, Uganda, and Malaysia are organized annually. A project manager and a medical officer are placed at each site, along with approximately 10 venturers (age 17-25.) Participants are of all nationalities, but, at present, they are predominantly British.
Collapse
Affiliation(s)
- JP Barrett
- Raleigh International, London, U.K. and Hospital for Tropical Diseases Travel Clinic, London, U.K
| | | |
Collapse
|