title: Imported falciparum malaria in British troops returning from Kenya.
abstract: The objective of this study was to report on a breakthrough of Plasmodium falciparum infection following a military exercise in central Kenya and the treatment regimens used. A series of case reports are presented from the three UK hospitals involved. Among 150 British soldiers who had been on exercises for five weeks in central Kenya, taking proguanil/chloroquine anti-malarial prophylaxis, seven developed symptomatic falciparum malaria. Initial symptoms, which started between 2 and 10 days before their return to England, included faintness, sweating, shivering, diarrhoea, headache and myalgia. Diagnosis was delayed from between 5 and 13 days after the first symptom. One patient was severely ill with 50% parasitaemia: he required intensive care, exchange blood transfusion and haemofiltration for acute renal failure. Compliance with chemoprophylaxis was not measured and anti-mosquito measures were not generally practised. However, British Army policy was amended in June 1993 so that mefloquine will be used in future rather than proguanil/chloroquine. It was concluded therefore that even in an educated and motivated population simple preventive measures are not observed. Chemoprophylactic compliance could be improved by changing to a simpler regime. Falciparum malaria is a medical emergency that requires urgent admission for confirmation of diagnosis, supportive and curative treatment. Its presence should be suspected in any ill traveller.
authors.affiliation: Duchess of Kent's Military Hospital, Catterick Garrison, North Yorks.
authors.forename: J H
authors.initials: JH
authors.lastname: Miller
authors.forename: M
authors.initials: M
authors.lastname: Byers
authors.forename: R
authors.initials: R
authors.lastname: Whiteoak
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D006801:Humans; D007630:Kenya; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D008889:Military Personnel; D014195:Travel; D006113:United Kingdom
chemical_list: D000962:Antimalarials; D015767:Mefloquine