Falciparum Malaria in Patient 9 Years after Leaving Malaria-Endemic Area

To the Editor: A 30-year-old African man, without any specifi c medical history, came to the emergency department of Brugmann University Hospital in Brussels, Belgium, on March 18, 2008, because of malaise, profuse transpiration, and dizziness that day.He also reported a 3-day history of muscle pain and pain while urinating, for which his general practitioner prescribed ciprofl oxacin.Originally from Guinea-Conakry, the patient reported no travel outside Belgium after his arrival >9 years earlier.No recurrent fever episodes were noted during this period.Two weeks before becoming ill, a friend visiting from Guinea-Conakry stayed at his home for 7 days.Results of a physical examination were normal, except for a temperature of 37.5°C.Blood analysis showed moderate anemia (hemoglobin 12.9 g/dL) and thrombocytopenia (platelet count 73,000/μL) with total bilirubin and C-reactive protein levels of 1.5 mg/ dL and 7.0 mg/dL, respectively.Because we suspected subfebrile malaria in this patient, a blood smear was prepared.It showed ring-shaped trophozoites of Plasmodium falciparum with a parasite density of 0.1%.Serologic tests showed an antibody titer to Plasmodium spp. of 3,200.A blood sample was sent to the national reference laboratory at the Institute of Tropical Medicine in Antwerp.The diagnosis of P. falciparum malaria was confi rmed by microscopy and real-time PCR.Follow-up was uneventful because the patient responded to a 7-day course of oral quinine and doxycycline.Malaria, a potential life-threatening disease caused by P. falciparum, usually occurs within 2 months after the bite of an infective mosquito.