title: A case of quadruple malaria infection imported from Mozambique to Japan.
abstract: A 35-year-old Japanese man had an intermittent fever and mild headache for eight weeks after he returned to Japan from working in Mozambique. He had taken antimalarial prophylaxis (doxycycline) for 25 weeks, and stopped taking this drug two weeks after his return. Microscopic examination of a peripheral blood smear showed a mixed infection with Plasmodium vivax, P. falciparum, and P. ovale. In addition, a nested polymerase chain reaction and subsequent sequencing detected specific DNA sequences of four species of Plasmodium, including P. malariae. The patient was successfully treated with artemether-lumefantrine and primaquine phosphate. The present case is a rare instance of a mixed infection with four species of Plasmodium. Nonimmune persons in malaria-endemic areas may have a risk of mixed infection. All four species must be identified by using sensitive and specific tests, such as a nested polymerase chain reaction, in addition to conventional morphologic identification.
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Oki
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan sa@is.icc.u-tokai.ac.jp.
authors.forename: Satomi
authors.initials: S
authors.lastname: Asai
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Saito-Nakano
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Taira
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tachibana
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohmae
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Nozaki
authors.affiliation: Department of Internal Medicine, Department of Laboratory Medicine, and Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan; Clinical Laboratory Center, Tokai University Hospital, Isehara, Kanagawa, Japan; Department of Parasitology, National Institute of Infectious Diseases, Shinjuku, Tokyo, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Miyachi
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use; D001483:Base Sequence; D060085:Coinfection; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D004318:Doxycycline / Q000627:therapeutic use; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use; D005449:Fluorenes / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D008297:Male; D008969:Molecular Sequence Data; D009073:Mozambique; D018512:Parasitemia; D010961:Plasmodium / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D020641:Polymorphism, Single Nucleotide; D011319:Primaquine / Q000627:therapeutic use; D016415:Sequence Alignment; D017422:Sequence Analysis, DNA; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D016054:DNA, Protozoan; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011319:Primaquine; D004318:Doxycycline
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