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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 166-169

Imported vivax malaria: A case report and a literature review


Department of Laboratories, Hematology Unit, Al Nuaman Teaching Hospital, Baghdad, Iraq

Date of Submission07-Feb-2020
Date of Acceptance05-Apr-2020
Date of Web Publication10-Nov-2020

Correspondence Address:
Dr. Basma Dawood Hanoon
Al Nuaman Teaching Hospital, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijh.ijh_8_20

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  Abstract 


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

How to cite this URL:
Hanoon BD. Imported vivax malaria: A case report and a literature review. Iraqi J Hematol [serial online] 2020 [cited 2020 Nov 24];9:166-9. Available from: https://www.ijhonline.org/text.asp?2020/9/2/166/300426




  Introduction Top


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 Top


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 Top


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 Top


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.



 
  References Top

1.
Bruneel F, Tubach F, Come P. Sever imported falciparum malaria: A cohort study in 400 critically ill adults. PLoS One 2010;5:E13236.  Back to cited text no. 1
    
2.
World Health Organization; 2014. World Malaria Report. Geneva: World Health Organization; 2012. Available from: http://www.who.int/malaria/publications/world-malaria-report-2014. [Last accessed on 2019 Nov 07].  Back to cited text no. 2
    
3.
World Health Organization. WHO EMRO. Malaria Programmes Iraq. World Health Organization; 2018. Available from: http://www.emro.who.int/malariairq. [Last accessed on 2019 Nov 07].  Back to cited text no. 3
    
4.
World Health Organization. Malaria Terminology. Geneva: World Health Organization; 2016. Available from: http://www.who.int. [Last accessed on 2019 Nov 07].  Back to cited text no. 4
    
5.
Martens P, Hall L. Malaria on the move: Human population movement and malaria transmission. Emerg Infect Dis 2000;6:103-9.  Back to cited text no. 5
    
6.
Tamia AJ, Smith DL. International population movement and regional Plasmodium falciparum malaria elimination strategy. Proc Natle Acad USA 2010;107:12222.  Back to cited text no. 6
    
7.
Andriopoulos P, Economopoulou A, Spanakos G, Assimakopoulos G. A local outbreak of autochthonous Plasmodium vivax malaria in Laconia, Greece – A re-emerging infection in the Southern borders of Europe? Int J Infect Dis 2013;17:e125-8.  Back to cited text no. 7
    
8.
Albuquerque HG, Peiter PC, Toledo LM, Sabroza PC, Pereira RD, Caldas JP, et al. Imported malaria in Rio de Janeiro state between 2007 and 2015: An epidemiologic approach. Mem Inst Oswaldo Cruz 2019;114:e190064.  Back to cited text no. 8
    
9.
de Pina-Costa A, Brasil P, Di Santi SM, de Araujo MP, Suárez-Mutis MC, Santelli AC, et al. Malaria in Brazil: What happens outside the Amazonian endemic region. Mem Inst Oswaldo Cruz 2014;109:618-33.  Back to cited text no. 9
    
10.
Lorenz C, Virginio F, Aguiar BS, Suesdek L, Chiaravalloti-Neto F. Spatial and temporal epidemiology of malaria in extra-Amazonian regions of Brazil. Malar J 2015;14:408.  Back to cited text no. 10
    
11.
Kasliwal P, Rao MS, Kujur R. Plasmodium vivax malaria: An unusual presentation. Indian J Crit Care Med 2009;13:103-5.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Mendis K, Sina BJ, Marchesini P, Carter R. The neglected burden of Plasmodium vivax malaria. Am J Trop Med Hyg 2001;64:97-106.  Back to cited text no. 12
    
13.
Sreehari D, Sigh VB, Chetan KH, Babulal MP. Vivax malaria causing subconjuctival haemorrhage: Case report. J Bacteriol Parasitol 2013;4:225.  Back to cited text no. 13
    
14.
Lee YC, Tang CS, Ang LW, Han HK, James L, Goh KT. Epidemiological characteristics of imported and locally-acquired malaria in Singapore. Ann Acad Med Singapore 2009;38:840-9.  Back to cited text no. 14
    
15.
Arben N, Diana H, Anduena N, Klodiana S, Dhimiter K, Najada Ç, et al. Case report epidemiological, clinical and therapeutic aspects of cerebral malaria imported in Albania. J Infect Dev Ctries 2016;10:190-4.  Back to cited text no. 15
    
16.
Newman RD, Parise ME, Barber AM, Steketee RW. Malaria -related deaths among U.S. travelers, 1963-2001. Ann Intern Med 2004;141:547-55.  Back to cited text no. 16
    
17.
Ladhani S, El Bashir H, Patel VS, Shingadia D. Childhood malaria in East London. Pediatr Infect Dis J 2003;22:814-9.  Back to cited text no. 17
    
18.
McCaslin RI, Pikis A, Rodriguez WJ. Pediatric Plasmodium falciparium malaria: A ten-year experience from Washington, DC. Pediatr Infect Dis J 1994;13:709-15.  Back to cited text no. 18
    
19.
Cunha BA. The diagnosis of imported malaria. Arch Intern Med 2001;161:1926-8.  Back to cited text no. 19
    
20.
Ladhani S, Patel VS, El Bashir H, Shingadia D. Changes in laboratory features of 192 children with imported falciparum malaria treated with quinine. Pediatr Infect Dis J 2005;24:1017-20.  Back to cited text no. 20
    
21.
Patel U, Gandhi G, Friedman S, Niranjan S. Thrombocytopenia in malaria. J Natl Med Assoc 2004;96:1212-4.  Back to cited text no. 21
    
22.
Chiodini PL, Patel D, Whitty CJ, Lalloo DG. Guidelines for Malaria Prevention in Travellers from the United Kingdom. London: Public Health England; October, 2017. Available from: https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk for the most up to date version. [Last accessed on 2020 May 22].  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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