title: Fatal falciparum malaria in Canadian travellers.
abstract: The authors report 2 cases of severe falciparum malaria in Canadians that had fatal outcomes. In the first case a man presented to a local hospital shortly after returning from Africa, but a diagnosis of malaria was not considered. He was transferred to a secondary and then to a tertiary care facility, where he subsequently died. Intravenous quinidine therapy, the treatment of choice, was unavailable at all 3 hospitals. In the second case, a woman taking chloroquine prophylaxis while visiting Nigeria developed cerebral malaria and died. These cases illustrate critical management issues: appropriate advice on malaria prevention before departure; consideration of malaria in all febrile people returning from an endemic area; ready access to parenteral therapy for severe malaria in Canadian hospitals; and an increase in awareness of travel medicine among family physicians.
authors.affiliation: Department of Medicine, University of Toronto, Ont.
authors.forename: A
authors.initials: A
authors.lastname: Humar
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: D
authors.initials: D
authors.lastname: Zoutman
authors.forename: K C
authors.initials: KC
authors.lastname: Kain
mesh_terms: D000349:Africa; D000368:Aged; D002170:Canada; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016779:Malaria, Cerebral / Q000175:diagnosis; D016778:Malaria, Falciparum / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D014195:Travel