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| CASE REPORT |
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| Year : 2020 | Volume
: 9
| Issue : 2 | Page : 166-169 |
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Imported vivax malaria: A case report and a literature review
Basma Dawood Hanoon
Department of Laboratories, Hematology Unit, Al Nuaman Teaching Hospital, Baghdad, Iraq
| Date of Submission | 07-Feb-2020 |
| Date of Acceptance | 05-Apr-2020 |
| Date of Web Publication | 10-Nov-2020 |
Correspondence Address:
Dr. Basma Dawood Hanoon
Al Nuaman Teaching Hospital, Baghdad
Iraq
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijh.ijh_8_20
Imported malaria is defined as an infection acquired in a malaria-endemic area but diagnosed in a nonendemic country after the development of clinical symptoms. The fatality rate of malaria in the nonendemic area was 60 times higher than that in endemic areas, mainly because of the late diagnosis and treatment. Here, we report a 23-year-old Bangladesh male worker in a cleaning company was admitted to the Al Nuaman Teaching Hospital on May 22, 2018, with high-grade fever and abdominal pain of 2 days duration. In medical history, he had been diagnosed with malaria since childhood. The case report is presented with a review of the literature. Microscopy remains the gold standard diagnostic tool of malaria, thick and thin smears ± rapid diagnostic tests should be performed on all febrile returned travelers from risk areas.
Keywords: Imported, malaria, report
How to cite this article:
Hanoon BD. Imported vivax malaria: A case report and a literature review. Iraqi J Hematol 2020;9:166-9 |
| Introduction | |  |
Malaria continues to be a major problem of global health.[1] Despite various strategies taken by the government and World Health Organization (WHO), malaria still a major cause of death in many countries, including Bangladesh.[2] Despite the difficult situation in Iraq, great progress has been made in the field of malaria, the past two indigenous malaria cases in Iraq were reported in 2008. Currently, Iraq is developing a national strategy of malaria for 2016–2020.[3] Imported malaria defined as an infection acquired in a malaria-endemic area but diagnosed in nonendemic countries after the development of clinical signs and symptoms.[4]
The movement of malaria parasites by human migration or population movement from one country to another may cause disease spread to nonendemic areas or areas, where malaria was previously eliminated [5],[6] with anopheles vectors still present in many nonendemic countries,[7] so imported cases can cause secondary transmission.[8]
The fatality rate of malaria in the nonendemic area was 60 times higher than that in endemic areas, mainly because of the late diagnosis and treatment of patients, as health professionals in nonendemic areas lack the expertise and orientation to handle such cases.[9],[10]
It is a mosquito-borne disease caused by Plasmodium vivax, Plasmodium falciparum, Plasmodium Ovale, and Plasmodium malariae. Malaria caused by P. vivax is more common than malaria caused by P. falciparum.[11],[12] However, disease severity and complications are more described in falciparum malaria.[13]
| Case Report | | |
A 23-year-old Bangladesh male worker in a cleaning company was admitted to the Al Nuaman Teaching Hospital on May 22, 2018, with high-grade fever and abdominal pain of 2 days duration. Fever was high grade from the beginning, sometimes with swinging rise, and was associated with chills and rigors. The patient experienced profuse sweating when the fever subsided. Fever was associated with headache, myalgia, and fatigue. He had no significant event in the past few months except his return from Bangladesh. In medical history, he had been diagnosed with malaria since childhood. When we examined the patient, he was very toxic, his temperature was 39.5°C, pulse rate 120/min, and blood pressure 110/70 mmHg. Anemia, jaundice, cyanosis, and clubbing were absent. Jugular venous pressure was not raised. The abdomen was soft and tender. The examination finding of respiratory, cardiac, and other major systems was normal. His blood reports including complete blood count, packed cell volume 0.38 l/L, white blood cell 11.0 × 109/L, and PL 53 × 109/L.
Thick and thin blood films confirmed the presence of P. vivax. Multiple stages of P. vivax, including trophozoites, schizonts, and gametocytes, were detected in the blood smears as shown in figures [from [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]. The patient started to improve from the following day after starting antimalarial drugs. Pain and fever subsided, and the patient was able to eat, drink, and perform all daily activities within 3 days and was discharged from the hospital without any complication. One-month postdischarge remained well, and subsequent blood films were negative. | Figure 1: Blood flim for malarial parasite showing trophozoite stage of Plasmodium vivax within red blood cells (×100)
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 | Figure 2: Blood flim for malarial parasite showing macrogametocyte stage of Plasmodium vivax within red blood cells (×100)
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 | Figure 3: Blood flim for malarial parasite showing microgametocyte stage of Plasmodium vivax within red blood cells (×100)
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 | Figure 4: Blood flim for malarial parasite showing young schizont stage of Plasmodiumvivax within red blood cells (×100)
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 | Figure 5: Blood flim for malarial parasite showing oval shape gametocyte stages of Plasmodium vivax within red blood cells (×100)
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 | Figure 6: Blood flim for malarial parasite showing schizont stage of Plasmodium vivax within red blood cells (×100)
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 | Figure 7: Blood flim for malarial parasite showing double-ring stage of Plasmodium vivax within red blood cells (×100)
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 | Figure 8: Blood flim for malarial parasite showing microgametocyte stage of Plasmodium vivax within red blood cells (×100)
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 | Figure 9: Blood flim for malarial parasite showing ring stages of Plasmodium vivax within red blood cells (×100)
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| Discussion | | |
Regarding screening program for the importation of vivax malaria by asymptomatic worker, as blood films could be repeatedly negative for malaria parasites during the exoerythrocytic phase of the life cycle, so the pickup rate of malaria parasites among asymptomatic foreign workers was extremely low, at around 0.1%,[14] patients who have resided from endemic countries and have shown signs of febrile symptoms should be considered for imported malaria.[15]
The patient's delay and doctor's delay are well-described risk factors for mortality in imported malaria.[16] Because delays in diagnosis are associated with an increased risk of developing severe malaria, requirement for intensive care,[17],[18] and death.[19] Thrombocytopenia (platelet levels <150 × 109/L) is a characteristic feature of malaria, present in around 45%–71% of imported malaria in both children and adults.[20] Thrombocytopenia in children with fever is highly predictive of malaria following travel to a malaria-endemic area.[21] It is important to consider fever seriously when dealing with those job seekers coming from a malaria risk area.[22]
| Conclusion | | |
Bad control of malaria in endemic countries is likely to increase the risk of malaria among travelers and job seekers.
Blood film remains the gold standard diagnostic technique and is the only tool that can distinguish asexual from sexual parasitemia. Thick and thin smears ± rapid diagnostic tests should be performed on all febrile returned travelers from risk areas.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
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