[Imported tropical malaria after a sojourn in Kenya. Serious consequences of neglected chemoprophylaxis and delayed diagnosis].
METHODS
A 56-year-old man was admitted to the hospital 11 days after returning from Kenya because of recurrent fever attacks. The patient had not taken malaria chemoprophylaxis and had previously received symptomatic treatment for suspected viral infection by his general practitioner. Physical findings on admission included enlargement of liver and spleen, marked dehydration and a body temperature of 40.1 degrees C.


METHODS
Initial chest radiography showed no abnormalities. Thick and thin blood smears were positive for Plasmodium falciparum. Initial parasitemia was 0.5 per thousand.


METHODS
Despite immediate quinine therapy including loading dose and intensive care treatment complicated malaria with multiorgan failure developed. The patient required mechanical ventilation, high-dose catecholamine treatment and hemodialysis for several days. The course of parasitemia peaked on treatment day 2 at a level of 31.1 per thousand.


CONCLUSIONS
Our case shows serious consequences and important complications of Plasmodium falciparum malaria in a patient without chemoprophylaxis and with delayed diagnosis. Fever following a stay in the tropics requires immediate testing for malaria infection.
Schwake
L
L
Abteilung für Gastroenterologie, Infektionskrankheiten und Vergiftungen, Universitätsklinikums Heidelberg. Lukas_Schwake@med.uni-heidelberg.de
Junghanss
T
T
Weimann
J
J
Stremmel
W
W
D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D005334:Fever; D006801:Humans; D007630:Kenya; D008099:Liver / Q000473:pathology; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D018512:Parasitemia / Q000469:parasitology; D010963:Plasmodium falciparum / Q000254:growth & development / Q000302:isolation & purification*; D011803:Quinine / Q000627:therapeutic use*; D013902:Radiography, Thoracic; D006435:Renal Dialysis; D013154:Spleen / Q000473:pathology; D014195:Travel
D000962:Antimalarials; D011803:Quinine