[Subacute Plasmodium falciparum malaria in 43 patients returning from areas with chloroquine in Africa].
OBJECTIVE
To identify clinical and biological features of subacute falciparum malaria, risk factors, and to evaluate the efficacy of curative treatment.


METHODS
Diagnostic criteria were the association of apyrexia, anemia, little or no parasitemia and a high titer of anti-Plasmodium antibodies. Forty-three cases were observed in subjects returning from chloroquine-resistant areas in Africa. They were matched with controls for age, country of residence and duration of stay. Controls were missionaries who attended our unit for a routine medical check-up during the study period.


RESULTS
The clinical presentation and biological features were similar to "malarial cachexia", a condition mainly described in non-immune children in endemic areas. Splenomegaly was present in 58% of the patients. Biological features included little or no parasitemia, an overall decrease in the blood cell count, an increased erythrocyte sedimentation rate and a high titer of anti-Plasmodium antibodies. This syndrome was not correlated with the frequency of chloroquine resistance, the area of stay (urban or rural) or to the kind of chemoprophylaxis.


CONCLUSIONS
This study describes subacute resistant falciparum malaria in patients who had prolonged stay in chloroquine-resistant areas of Africa associating splenomegaly, cytopenia and a low or absent parasitemia. Subacute chloroquine-resistant malaria could be due to host factors which remained to be determined by prospective immunological studies. Curative treatment with mefloquine is effective.
Lortholary
O
O
Département des Maladies Infectieuses, Parasitaires, Tropicales et Santé Publique, Groupe Hospitalier Pitié-Salpêtrière, Paris.
Danis
M
M
Casassus
P
P
Felix
H
H
Gay
F
F
Datry
A
A
Gentilini
M
M
D000328:Adult; D000349:Africa / Q000453:epidemiology; D000368:Aged; D000913:Antibodies, Protozoan / Q000032:analysis; D001772:Blood Cell Count; D002738:Chloroquine; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014195:Travel
D000913:Antibodies, Protozoan; D002738:Chloroquine; D015767:Mefloquine
Paludisme subaigu à Plasmodium falciparum chez 43 sujets revenant de régions de chloroquinorésistance en Afrique.