title: [Delayed diagnosis of malaria in a dengue endemic area in the Brazilian extra-Amazon: recent experience of a malaria surveillance unit in state of Rio de Janeiro].
abstract: BACKGROUND
  The mortality of malaria in the extra-Amazon region is about 80 times higher than in the Amazon region, where malaria is concentrated (99.8% of cases). In areas of dengue transmission, delay in the diagnosis and treatment of malaria in patients with fever who reside in areas of malaria transmission can be due to the confusion between the clinical diagnoses of both diseases by nonspecialist doctors, among other factors. This work presents some of the consequences of delayed diagnosis in three patients with malaria by Plasmodium falciparum, P. malariae and P. vivax, who, after following the usual route for Dengue treatment, sought our institution, where they were correctly diagnosed and adequately treated.
  
  
  METHODS
  Description of three cases of malaria with delayed diagnosed malaria referred to the Outpatient Clinic for Acute Febrile Diseases, IPEC/FIOCRUZ-RJ, between 2007 and 2008.
  
  
  RESULTS
  A Brazilian from Mozambique, primo-infected with P. falciparum was diagnosed with malaria six days after the onset of fever and died of cerebral malaria and shock. Another patient with P.malariae malaria presented a severe and prolonged course, but was cured after specific treatment. A third patient, with delayed diagnosis of P. vivax malaria, acquired it in the Atlantic Forest region in the State of Rio.
  
  
  CONCLUSIONS
  Health professionals from non-endemic areas for malaria should be trained to optimize the surveillance and early treatment of malaria and prevent morbid and fatal outcomes. An investigation of outbreaks of autochthonous malaria in the State of Rio de Janeiro is suggested.
authors.affiliation: Serviço de Doenças Febris Agudas, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ.
authors.forename: Anielle de Pina
authors.initials: Ade P
authors.lastname: Costa
authors.forename: Clarisse da Silveira
authors.initials: Cda S
authors.lastname: Bressan
authors.forename: Renata Saraiva
authors.initials: RS
authors.lastname: Pedro
authors.forename: Rogério
authors.initials: R
authors.lastname: Valls-de-Souza
authors.forename: Sidnei da
authors.initials: Sd
authors.lastname: Silva
authors.forename: Patrícia Rosana de
authors.initials: PR
authors.lastname: Souza
authors.forename: Lusiele
authors.initials: L
authors.lastname: Guaraldo
authors.forename: Maria de Fátima
authors.initials: Mde F
authors.lastname: Ferreira-da-Cruz
authors.forename: Cláudio Tadeu
authors.initials: CT
authors.lastname: Daniel-Ribeiro
authors.forename: Patrícia
authors.initials: P
authors.lastname: Brasil
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D057210:Delayed Diagnosis; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D008297:Male