Letters to the Editor

Diagnosis of Malaria Should Be Considered by U.S. Physicians

Am Fam Physician. 2004 Jul 15;70(2):260-261.

to the editor: I read with great interest the article, “Prevention of Malaria in Travelers”1 in the August 1, 2003 issue of American Family Physician. The authors provide an excellent introduction to prophylactic measures against malaria in nonimmune travelers, with a special emphasis on protective gear, chemoprophylaxis, and patient education.

Because of global travel, family physicians in the United States must have an increasingly high index of suspicion for malaria. Two groups of persons should be considered with regard to imported malaria:persons who are nonimmune and immigrants to the United States. Persons not previously exposed (i.e., nonimmune) have an atypical clinical picture that often leads to delays in diagnosis. In an atypical clinical presentation, patients may present with symptoms of diarrhea, cough, and myalgias; the classic tertian (fever occurring every 48 hours) or quartan (occurring every 72 hours) pattern rarely will be present; and they will have a delayed onset of symptoms after travel to an endemic area. In addition, the use of over-the-counter medication may blunt the fever and other symptoms. The atypical presentation of malaria in the nonimmune population should prompt early examination of blood smears in any patient with fever and a history of travel. Plasmodium falciparum malaria in a nonimmune patient should be treated as an emergency, because without treatment this type of malaria can be lethal in only hours.2

It also is increasingly common for immigrants to present to the emergency department seeking care for typical malaria symptoms. These patients may tell the physicians that they have malaria. Promptly performing a blood smear in these patients will save time and unnecessary testing.3

References

1. Lo Re V 3d, Gluckman SJ. Prevention of malaria in travelers. AM Fam Physician 2003;68:509–14.

2. Wichmann O, Loscher T, Jelinek T. Fatal malaria in a German couple returning from Burkina Faso. Infection. 2003;31:260–2.

3. Causer LM, Newman RD, Barber AM, Roberts JM, Stennies G, Bloland PB, et al. Malaria surveillance—United States, 2000. MMWR Surveill Summ. 2002;51:9–23.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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