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CDC Urges Doctors to Be Alert for Malarial Relapses

Case report on Nigerian immigrant shows that relapse can occur years after initial infection


MONDAY, Dec. 12 (HealthDay News) -- Although malaria in the United States usually occurs in travelers who don't follow disease-prevention recommendations, it can reoccur in residents who haven't traveled in years, according to a case report published in the Dec. 9 issue of the Morbidity and Mortality Week Report. The case involved a 23-year-old Nigerian immigrant who experienced a malaria relapse after four symptom-free years as a U.S. resident.

The patient sought care at a Philadelphia-area hospital emergency department in November 2004 after 10 days of nocturnal fevers, chills and night sweats. He had undergone malaria treatments in his native country, but reported that he had not experienced any unexplained episodes of fever or traveled outside Philadelphia during the previous four years.

Doctors determined that his malaria was caused by Plasmodium ovale, one of the four species of Plasmodium parasite that are transmitted by mosquitoes. His symptoms resolved after seven days of treatment with quinine and doxycycline.

Approximately 1,300 cases of malaria are reported each year in the United States. "The case described in this report highlights the importance of taking a complete travel and immigration history from persons with unexplained febrile illnesses," the authors write. "Health-care practitioners should consider malaria in their differential diagnoses of patients who have unexplained fever and 1) have a history of malaria, 2) have lived in a malaria-endemic country, or 3) have traveled to a malaria-endemic country. A malaria blood film should be performed and appropriate treatment administered."

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