Outbreak investigation of needle sharing-induced malaria, Ahvaz, Iran.
BACKGROUND
Humans acquire malaria from the bite of infected anopheline mosquitoes. Malaria is very rarely acquired by needle sharing among intravenous drug users (IVDUs). The aim of this report is to describe the role of injecting drug usage in malaria outbreaks occurring in malaria-free regions.


METHODS
This investigation was conducted to control a febrile illness occurring in IVDUs in a camp near Ahvaz, a city in the southwest of Iran, during the summer of 2000. All 98 men (mean age 25 years) in this camp took part in the study. A questionnaire was completed for data collection. Peripheral blood smears were examined for Plasmodium by Wright and Giemsa staining. Those who were positive for Plasmodium were treated with chloroquine 600 mg immediately on day 1, with a 300 mg follow-up dose 6h later; this was followed by 300 mg doses on days 2 and 3.


RESULTS
Twenty-seven patients (27.6%) were positive for Plasmodium falciparum, and all of them had shared needles and syringes in the days before their illness. One of the men had been transferred into the camp from Bandar Abbas two weeks previously . There were no anopheline mosquitoes in the camp environment and none within a 1-km radius. There had been no report of malaria transmission previously in this camp, nor among the population living within the 1-km radius. All of the cases (100%) were negative for P. falciparum at follow-up examination.


CONCLUSIONS
With regard to increasing injecting drug addiction and the presence of malaria in some parts of Iran, malaria should be included in the differential diagnosis of IVDU cases with fever.
Alavi
Seyed Mohammad
SM
Infectious and Tropical Diseases Research Center, Infectious Disease Ward, Razi Hospital, Joundishapour University of Medical Sciences, Ahvaz, Iran. alavi1329dr@yahoo.com
Alavi
Leila
L
Jaafari
Farhad
F
D000293:Adolescent; D000328:Adult; D001769:Blood / Q000469:parasitology; D004196:Disease Outbreaks; D006801:Humans; D007492:Iran / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000635:transmission*; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000009:adverse effects*; D010963:Plasmodium falciparum / Q000302:isolation & purification; D015819:Substance Abuse, Intravenous / Q000150:complications*; D055815:Young Adult