Chronic falciparum malaria causing massive splenomegaly 9 years after leaving an endemic area

Howden, Benjamin P; Vaddadi, Gautam; Manitta, Joseph; Grayson, M Lindsay

doi:10.5694/j.1326-5377.2005.tb06652.x

Cited by 15 publications

(10 citation statements)

References 13 publications

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“…Splenomegaly has been reported in three cases of delayed malaria. 13,14 Interestingly, in two of these cases, clinical malaria occurred after splenectomy, 13 whereas parasitemia was undetectable before surgery. The spleen being critical to allow for effective clearance of Plasmodium-infected red blood cells, 15 these cases illustrate the persistence of chronic submicroscopic P. falciparum infection.…”

Section: Discussionmentioning

confidence: 96%

Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

Dauby

Ferreira

Konopnicki³

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Emerging evidence indicates that migrants from endemic regions are at risk of delayed presentation of malaria. We report three cases of malaria occurring years after arrival in Europe. All patients were originally from Sub-Saharan Africa. Two subjects had controlled human immunodeficiency virus infection and one was a pregnant woman. We performed a literature review of all published cases of delayed presentation of in migrants and identified 32 additional cases. All cases but one originate from sub-Saharan Africa. There was a median time of 36 months between the last visit to a malaria-endemic country and clinical malaria (range: 3 months to 10 years). Pregnancy was the most frequently reported risk factor (11/35 or 31.4%). Parasitemia was ≤ 0.1% in 38% of cases (11/29 reported), and no death was reported. The underlying possible mechanisms for this delayed presentation in migrants from an endemic area probably include the persistence of submicroscopic parasitemia combined with decaying -specific immunity. Suspicion of delayed malaria should remain high in migrants, mainly from sub-Saharan Africa, even without a recent travel history, especially in those presenting risk factors for impaired parasite clearance or distinct immune responses such as pregnancy and HIV infection. In these patients, new prevention and screening strategies should be studied and blood safety policies adapted.

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Section: Discussionmentioning

confidence: 96%

Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

Dauby

Ferreira

Konopnicki³

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…Similarly, a case report in Australia described a 28-years-old woman, born and brought up in Eritrea and Sudan, who developed falciparum malaria following splenectomy nine years after arriving in Australia. Histopathological findings in the spleen were compatible with HMS [ 16 ]. Examples of chronic falciparum infection, such as these from non-endemic countries, are very informative since the possibility of re-infection can be excluded with confidence.…”

Section: Introductionmentioning

confidence: 99%

The duration of Plasmodium falciparum infections

Ashley

White

2014

Malar J

140

117

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Plasmodium vivax and Plasmodium ovale are often considered the malaria parasites best adapted to long-term survival in the human host because of their latent exo-erythrocytic forms. The prevailing opinion until the middle of the last century was that the maximum duration of Plasmodium falciparum infections was less than two years. Case reports and series investigating blood donors following accidental malaria infection of blood transfusion recipients and other sporadic malaria cases in non-endemic countries have shown clearly that asymptomatic P. falciparum infections may persist for up to a decade or longer (maximum confirmed 13 years). Current policies in malaria-free countries of excluding blood donors who have lived in malarious areas are justified. Vigilance for longer than three years after declaring elimination in an area may be needed.

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“…We believe that screening and treatment for malaria in people migrating to Australia from malaria‐endemic regions is an essential part of the initial health assessment, and should be performed as soon as possible after arrival. Individuals with untreated P. falciparum malaria, including those with minimally symptomatic or asymptomatic infection, can: (i) progress to developing severe malaria, even after prompt initiation of appropriate treatment; (ii) potentially reintroduce malaria into Australia if they settle or travel to a malaria‐receptive zone; (iii) have persistent symptomatic anaemia; and/or (iv) present months or even years later with symptomatic disease 18 …”

Section: Discussionmentioning

confidence: 99%

Outpatient treatment of malaria in recently arrived African migrants

Chih

Heath

Murray

2006

Medical Journal of Australia

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Objective: To describe the clinical features and management of African migrants recently arrived in Western Australia and subsequently diagnosed with malaria. Design, participants and setting: Retrospective case record analysis of African migrants aged ≥ 16 years with malaria referred to Royal Perth Hospital (RPH) from the WA Migrant Health Unit (MHU) between 1 March 2003 and 30 September 2005. Main outcome measures: Demographic variables; clinical and laboratory variables; Plasmodium species; antimalarial medications used and their efficacy. Results: 57 (3.5%) of 1609 adult African migrants screened at the MHU were diagnosed with malaria and referred for treatment. 52 were infected with P. falciparum, two with P. ovale, one with P. malariae, and one with both P. falciparum and P. malariae; the malaria parasite could not be identified in one individual. No patients had severe malaria by World Health Organization criteria. Most patients (53/57) were treated as outpatients with oral antimalarial therapy; four patients without severe malaria were admitted to hospital for treatment and observation. Atovaquone–proguanil was the antimalarial medication most commonly used (in 52/57), and treatment was well tolerated in most patients. Post‐treatment follow‐up was possible in 50 patients; all 27 of those who were followed for 4 weeks or longer were cured. Cure could not be concluded in patients with shorter follow‐up periods. All follow‐up blood films were negative for malarial parasites. Conclusions: Outpatient treatment of malaria in recently arrived adult African migrants appeared to be safe and efficacious in our cohort.

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Chronic falciparum malaria causing massive splenomegaly 9 years after leaving an endemic area

Cited by 15 publications

References 13 publications

Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

The duration of Plasmodium falciparum infections

Outpatient treatment of malaria in recently arrived African migrants

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