title: The challenge of diagnosing Plasmodium ovale malaria in travellers: report of six clustered cases in French soldiers returning from West Africa.
abstract: BACKGROUND
  Plasmodium ovale is responsible for 5% of imported malaria in French travellers. The clinical and biological features of six clustered cases of P. ovale malaria in an army unit of 62 French soldiers returning from the Ivory Coast are reported.
  
  
  METHODS
  All patients were symptomatic and developed symptoms on average 50 days after their return and 20 days after the end of chemoprophylaxis (doxycycline). Clinical features included fever (6/6), mostly tertian (4/6), aches (6/6), nausea (3/6), abdominal pain (2/6), diarrhoea (2/6), or cough (2/6). Thrombocytopaenia was lower than 100,000/mm3 in half the cases only, and the haemoglobin count was normal for all patients. The diagnosis was made after at least three thick and thin blood smear searches. Parasitaemia was always lower than 0.5%. All rapid diagnostic tests were negative for HRP2 and pLDH antigens.
  
  
  CONCLUSIONS
  Plasmodium ovale malaria is currently a problem to diagnose in travellers, notably in French soldiers returning from the Ivory Coast. Early attempts at diagnosis are difficult due to the lack of specific clinical features, the rarity of biological changes and the poor sensitivity of diagnostic tools to detect low parasitaemia. Thus, the diagnosis is commonly delayed or missed. Physicians should be aware of this diagnostic challenge to avoid relapses and provide prompt and adequate treatment with chloroquine and radical cure with primaquine.
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France.
authors.forename: Franck
authors.initials: F
authors.lastname: de Laval
authors.forename: Manuela
authors.initials: M
authors.lastname: Oliver
authors.forename: Christophe
authors.initials: C
authors.lastname: Rapp
authors.forename: Vincent
authors.initials: V
authors.lastname: Pommier de Santi
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mendibil
authors.forename: Xavier
authors.initials: X
authors.lastname: Deparis
authors.forename: Fabrice
authors.initials: F
authors.lastname: Simon
mesh_terms: D000328:Adult; D001769:Blood / Q000469:parasitology; D007560:Cote d'Ivoire; D005602:France; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000469:parasitology* / Q000473:pathology; D008297:Male; D008853:Microscopy; D008889:Military Personnel; D018512:Parasitemia / Q000175:diagnosis / Q000469:parasitology; D041122:Plasmodium ovale / Q000302:isolation & purification*; D014195:Travel