Search Results (52)

Background: Typhoid fever (TF) is a systemic infection caused by Salmonella enterica serovar Typhi, typically associated with regions where sanitation and access to clean water are inadequate. Although rare in non-endemic countries, TF remains a diagnostic consideration in travelers returning from endemic areas with febrile illness. Case report: We present the case of an 18-year-old female who developed TF following recent travel to Nigeria. The initial clinical presentation, including fever, dysuria, and abdominal pain, led to a misdiagnosis of acute pyelonephritis. Malaria, arboviral infections, acute viral hepatitis, and parasitic diseases were systematically ruled out through clinical evaluation, serological testing, and parasitological analysis. The clinical course was marked by fever, abdominal pain, somnolence, and hematological and hepatic abnormalities. Blood cultures confirmed the diagnosis, with the isolate verified and serotyped by the National Center of Infectious and Parasitic Diseases. Targeted antimicrobial treatment with ceftriaxone and levofloxacin resulted in full recovery, with no evidence of relapse or chronic carriage over a three-month follow-up period. Conclusions: This case highlights the critical importance of a structured differential diagnostic approach and microbiological confirmation in febrile patients with relevant travel history. In non-endemic settings, where TF may be underrecognized, early recognition, pathogen identification, and appropriate antimicrobial therapy remain essential to favorable outcomes and public health safety. Full article

Malaria remains a considerable challenge to international health, especially in returning travelers from endemic regions where exposure risk may be downplayed. Prompt and accurate diagnosis is crucial, especially when conventional diagnostic techniques are insufficient. This case report presents a 59-year-old man who developed fever, rash, and myalgia after returning from the Amazon rainforest. Initial laboratory tests demonstrated leukopenia, thrombocytopenia, transaminitis, and hyperbilirubinemia. Despite these abnormal results and a clinically suspicious presentation, malaria smears were negative. Since the symptoms did not resolve, a Karius test—a plasma-based microbial cell-free DNA sequencing assay—successfully detected the presence of Plasmodium vivax, thus establishing the diagnosis. The patient needed several treatment regimens for the recurrent attacks, including chloroquine and primaquine, artemether-lumefantrine, and eventually a combination of quinine and doxycycline together with a prolonged course of primaquine. His symptoms resolved completely after the last treatment regimen, along with the normalization of the blood counts and liver function tests. This case demonstrates the limitations of smear microscopy diagnosis in P. vivax infections, highlights the role of molecular diagnostics like the Karius test, and stresses the importance of preventing relapses with adequate hypnozoite clearance. It further highlights the importance of clinician awareness and diligent follow-up in cases of travel-related Malaria, especially those with unusual presentations or recurrent symptoms. Full article

Dengue and malaria are common vector-borne tropical diseases and are associated with high morbidity and mortality. Co-infection of dengue and malaria is underestimated due to parsimonious diagnostic approaches once the diagnosis of either is made, particularly using point-of-care assays, such as rapid diagnostic tests (RDTs). We present a case of dengue and Plasmodium vivax co-infection in a returned traveler from an endemic region, in whom the epidemiology and clinical course are highly suggestive of dengue triggering a P. vivax relapse. The literature on the co-occurrence of dengue and malaria in travelers is reviewed, as is the state of knowledge surrounding dengue as a precipitant to relapsing malaria. Full article

Background: Recurrent malaria refers to repeated episodes of the disease in the same individual. Plasmodium vivax is known for its ability to relapse due to dormant liver-stage hypnozoites and poses a particular risk to travelers returning from endemic areas. Prompt diagnosis and treatment are crucial to prevent recurrences. Case Presentation: We present the case of a 41-year-old man from Romania who developed Plasmodium vivax malaria after traveling through Southeast Asia without chemoprophylaxis. He presented with fever, chills, myalgia, headache, vomiting, and abdominal pain. Clinical findings included mild jaundice and slight neurological signs. Laboratory tests showed severe thrombocytopenia, elevated bilirubin, inflammatory markers, and borderline creatinine levels. Malaria was confirmed by a rapid diagnostic test and blood smear microscopy. The patient was treated with doxycycline and atovaquone–proguanil. He improved and was discharged, but experienced two relapses, both confirmed as Plasmodium vivax by RT-PCR. Despite receiving primaquine as radical cure after the first Plasmodium vivax malaria relapse, a second relapse occurred. Each episode was managed with blood-stage antimalarial therapy, leading to full clinical and biological recovery. Conclusions: Malaria rarely occurs in non-endemic areas; it should be considered in patients with compatible travel history and symptoms. Given the high relapse potential of Plasmodium vivax, accurate species identification is critical to guide appropriate long-term management. Full article

Given the overlap of epidemiological and clinical presentations of both rickettsioses and malaria infections, diagnostic testing where malaria is confirmed or excluded, without subsequent rickettsial testing, specifically in the case of Plasmodium vivax or P. ovale infection, may mask the possibility of relapse. A lack of clinical suspicion of co-infections, absence of knowledge on the geographic distribution of diseases, and lack of availability of point-of-care diagnostic testing for other tropical diseases can often lead to missed diagnosis or misdiagnosis of common tropical infections, including rickettsioses. We herein describe a case of confirmed intercurrent rickettsial and P. vivax infection, with the former potentially triggering a relapse of the latter in a febrile traveler returning to Canada from South America, and review the literature on tropical coinfections in returning travelers. Full article

Plasmodium falciparum malaria remains a major cause of morbidity and mortality, particularly in endemic regions. We report the case of a 21-year-old male with recent travel to an endemic area (Guapi, Colombia), who presented with febrile symptoms, severe respiratory distress, and oxygen saturation below 75%, necessitating orotracheal intubation. During the procedure, he developed pulseless electrical activity cardiac arrest, achieving return of spontaneous circulation after advanced resuscitation. Diagnosis was confirmed by thick blood smear, demonstrating P. falciparum infection. The patient progressed to multiorgan failure, including acute respiratory distress syndrome with capillary leak pulmonary edema, refractory distributive shock, acute kidney injury with severe hyperkalemia, and consumptive thrombocytopenia. Management included invasive mechanical ventilation, vasopressor support, sedation-analgesia, neuromuscular blockade, methylene blue, unsuccessful hemodialysis due to hemorrhagic complications, and platelet transfusions. Despite these interventions, the patient experienced a second cardiac arrest and died. This case highlights the severity and rapid progression of severe malaria with multisystem involvement, underscoring the critical importance of early diagnosis and intensive multidisciplinary management. It also emphasizes the need for preventive strategies for travelers to endemic areas and the development of clinical protocols to improve outcomes in complicated malaria. Full article

The risk of non-human primate (NHP) malaria transmission to humans is increasing, with Plasmodium knowlesi and Plasmodium cynomolgi emerging as significant zoonotic threats, particularly in Malaysia. While P. knowlesi is well-documented, P. cynomolgi infections in humans remain underreported, largely due to diagnostic challenges. Routine microscopy and standard molecular diagnostic tools often misdiagnose P. cynomolgi infections as P. vivax due to morphological similarities and genetic homology. We report a new case of a human P. cynomolgi infection misdiagnosed as Plasmodium vivax in a 32-year-old male with no prior malaria history or travel to endemic countries. The initial diagnoses made by the microscopy and qPCR conducted by the Kota Bharu Public Health Laboratory in Kelantan identified the infection as P. vivax. However, cross-examination by the Institute for Medical Research (IMR) revealed the presence of mixed-species infection, prompting further analysis. The real-time PCR and sequencing performed at MAPELAB, Spain, confirmed the co-infection of P. vivax and P. cynomolgi. This case highlights the diagnostic limitations in detecting P. cynomolgi, which shares high genetic similarity with P. vivax, leading to potential cross-reactivity and diagnostic inaccuracies. As P. cynomolgi emerges as the second zoonotic malaria species after P. knowlesi capable of infecting humans in Southeast Asia, improved diagnostic methods are urgently needed. Enhanced molecular diagnostics and comprehensive epidemiological studies are essential to elucidate transmission dynamics, assess public health implications, and inform effective malaria control strategies. Full article

Background: The availability of laboratory tests to screen and diagnose migrants and travellers for neglected and tropical parasitic diseases significantly impacts individual and public health. Italian scientific societies for parasitology, tropical diseases, and global health developed a survey to assess number and geographical localisation of laboratories able to carry out adequate diagnostics. Methods: An open-ended and multiple-choice questionnaire was constructed and sent to 752 members working in Italian microbiology laboratories via scientific societies’ mailing lists. Data concerning malaria, cystic echinococcosis, leishmaniasis, schistosomiasis, strongyloidiasis, and Chagas disease were included. Results: Members from 96 laboratories replied. At least one laboratory responded from 18 out of 20 Italian regions. Serological tests for Schistosoma spp., Strongyloides stercoralis, Trypanosoma cruzi, Echinococcus spp., and Leishmania spp. are performed in <50% of responding laboratories. Only 56.6% of labs provide all three recommended tests for malaria diagnosis in the emergency room. Direct identification methods availability varies for Schistosoma eggs (75–95.8%), S. stercoralis larvae (53.1%), trypomastigotes (59.4%), and Leishmania amastigotes (53.1%). Geographical differences (mainly northern versus southern regions) were evident. Conclusions: The survey underlines the need to improve diagnosis for neglected and tropical diseases, to define a network of reference laboratories for testing less prevalent diseases, and to share information, education, and training for both clinicians and microbiologists/parasitologists. Full article

The gold standard diagnosis for malaria is the microscopic visualization of blood smears to identify Plasmodium parasites, although it is an expert-dependent technique and could trigger diagnostic errors. Artificial intelligence (AI) tools based on digital image analysis were postulated as a suitable supportive alternative for automated malaria diagnosis. A diagnostic evaluation of the iMAGING AI-based system was conducted in the reference laboratory of the International Health Unit Drassanes-Vall d’Hebron in Barcelona, Spain. iMAGING is an automated device for the diagnosis of malaria by using artificial intelligence image analysis tools and a robotized microscope. A total of 54 Giemsa-stained thick blood smear samples from travelers and migrants coming from endemic areas were employed and analyzed to determine the presence/absence of Plasmodium parasites. AI diagnostic results were compared with expert light microscopy gold standard method results. The AI system shows 81.25% sensitivity and 92.11% specificity when compared with the conventional light microscopy gold standard method. Overall, 48/54 (88.89%) samples were correctly identified [13/16 (81.25%) as positives and 35/38 (92.11%) as negatives]. The mean time of the AI system to determine a positive malaria diagnosis was 3 min and 48 s, with an average of 7.38 FoV analyzed per sample. Statistical analyses showed the Kappa Index = 0.721, demonstrating a satisfactory correlation between the gold standard diagnostic method and iMAGING results. The AI system demonstrated reliable results for malaria diagnosis in a reference laboratory in Barcelona. Validation in malaria-endemic regions will be the next step to evaluate its potential in resource-poor settings. Full article

Lao People’s Democratic Republic (Lao PDR) has made significant progress in reducing malaria in recent years. In the Greater Mekong Subregion, forest-going is often a risk factor contributing to continuing malaria transmission. This study assessed forest-going and other potential risk factors for malaria cases in Champasak Province, Lao PDR. Routine passive surveillance data from August 2017 to December 2018 were extracted from health facilities in three districts for a case-control study; at the time of presentation, all fever cases were asked to report any recent forest travel. Multivariable logistic regression was used to assess the relationship between forest-going and malaria infection while controlling for other covariates. Of 2933 fever cases with data available on forest-sleeping and malaria diagnosis from 25 health facilities, 244 (8%) tested positive (cases), and 2689 (92%) tested negative (controls). Compared with spending 0–2 nights in the forest, spending 3–7 nights in the forest was associated with 9.7 times the odds of having a malaria infection (95% CI: 4.67–20.31, p < 0.001) when adjusting for gender, occupation, and season. Forest-going, especially longer trips, is associated with increased risk for confirmed symptomatic malaria in southern Lao PDR, and appropriate and targeted intervention efforts are needed to protect this high-risk population. Full article

Background and Clinical Significance: Fever in the returning traveler is a medical emergency warranting prompt exclusion of potentially life-threatening infections such as malaria. Case Presentation: We describe a case of a febrile returned traveler to South Africa whose prompt initial diagnostic work-up was notable for a false-positive malaria rapid diagnostic test (RDT), and who nevertheless responded quickly to oral atovaquone-proguanil, despite an ultimate diagnosis of African tick bite fever. Subsequent RDT and malaria thick- and thin-film blood examination failed to corroborate a diagnosis of malaria and all other microbiological testing other than rickettsial serology remained non-contributory. Conclusions: The case presented highlights important points regarding diagnostic test performance characteristics and premature diagnostic closure. Full article

Malaria is currently the most prevalent life-threatening infectious disease in the world. In this case report, we present a 44-year-old Caucasian woman with a low level of education and no significant past medical history who presented to the emergency room of the Emergency County Hospital of Arad, Romania, with a general affected state, a fever of 38.5 °C, chills, weakness, headache, muscle pain, nausea, icterus, and watery diarrheal stool. A viral infection was initially suspected, and the patient was transferred to the Infectious Diseases Department. The anamnesis revealed that the patient traveled to Nigeria (Ado Ekiti) and returned to Romania 14 days before presenting to the hospital without following antimalarial prophylaxis. A peripheral blood smear was conducted and revealed parasitemia with ring forms of Plasmodium falciparum (P. falciparum) of 10–15% within the red blood cells. Parasitemia increased within a day to 15–18%, and her health rapidly deteriorated. She was transferred to the Victor Babeș Infectious Disease Hospital in Bucharest for the urgent initiation of antimalarial treatment. The patient’s condition continued to worsen rapidly, and she succumbed to her illness due to multi-organ failure. This report details the first documented case of malaria imported from Nigeria to Romania. People traveling to malaria-endemic areas should be educated about preventing this parasitic infection, both by adopting measures to reduce the risk of mosquito bites and by using appropriate chemoprophylaxis. In the context of resuming travel after the COVID-19 pandemic, understanding and adhering to prophylactic measures is crucial to avoid tragic situations, as highlighted in this case report. Full article

Malaria is a major international public health problem. The risk of acquiring malaria varies depending on the intensity of transmission and adherence to mosquito precautions and prophylaxis recommendations. Severe malaria can cause significant multiorgan dysfunction, including acute kidney injury (AKI). Intravenous artesunate is the treatment of choice for severe malaria in non-endemic areas. One of the possible events connected with the lifesaving effects of artemisins is post-artesunate haemolysis (PADH), which may be potentially dangerous and under-recognised. We present a case of a seafarer with severe Plasmodium falciparum malaria complicated with AKI and PADH, with a good response to steroid treatment. This case highlights the need for malaria prophylaxis in business travellers, e.g., seafarers to malara-endemic regions, and close supervision of patients with malaria even after the completion of antimalarial treatment due to the possibility of late complications. Full article

Malaria has created a resurgence crisis in Zimbabwe’s elimination continuum, diverging from global commitment to malaria elimination by 2030. This retrospective cohort study aimed to determine the risk factors associated with severe malaria in the Beitbridge and Lupane districts. Multistage sampling was used to recruit 2414 individuals recorded in the District Health Information Software2 Tracker database. The study used IBM SPSS 29.0.2.0(20) for data analysis, and odds ratios (ORs) to estimate the relative risk (RR; 95% C.I; p < 0.05). The study revealed significant relative risks (p-value < 0.05) for individuals who had no Long-Lasting Insecticidal Nets (Beitbridge 47.4; Lupane 12.3), those who owned but used the LLINs (Beitbridge 24.9; Lupane 7.83), those who slept outdoors during the night (Beitbridge 84.4; Lupane 1.93), and adults (Beitbridge 0.18; Lupane 0.22) compared to the corresponding reference groups. Other factors showed varying RR: sex (Beitbridge 126.1), prompt treatment (Beitbridge 6.78), hosting visitor(s) (Lupane 6.19), and residence (Lupane 1.94) compared to the corresponding reference groups. Risk factor management needs to focus on increasing local awareness of malaria, universal LLINs coverage of indoor and outdoor sleeping spaces, community-based programs on proper and consistent LLIN usage, screening of visitors from malaria-endemic areas, comprehensive entomological activities, mixed malaria interventions in rural hotspots, and future research on local malaria transmission dynamics. While Zimbabwe has the potential to meet the global goal of malaria elimination, success depends on overcoming the risk factors to sustain the gains already made among malaria elimination districts. Full article

Malaria is a parasitic infection that may result in an acute, life-threatening illness. It is a major public health problem in the tropical world. The disease is caused by the parasites of the genus Plasmodium and is transmitted by female Anopheles mosquitoes. Saudi Arabia is in the elimination phase of malaria control. Several parts of Saudi Arabia report cases of imported malaria among travelers and visitors. The city of Makkah in Saudi Arabia has a population of about 2.3 million. Moreover, over 6 million religious visitors from different parts of the world visit Makkah annually. During the COVID-19 outbreak, travel restrictions were enforced in Makkah to contain the spread of COVID-19. We compare the total reported cases of malaria in Makkah before, during, and after COVID-19 travel restrictions in this retrospective cross-sectional study. Data on demographics, clinical data, and laboratory parameters were collected from the medical records of the Ministry of Health, Saudi Arabia. The annual malaria incidence rates in Makkah were 29.13/million people (2018), 37.82/million people (2019), 15.65/million people (2020), 12.61/million people (2021), and 48.69/million people (2022). Most of the malaria cases in Makkah were caused by Plasmodium falciparum, followed by P. vivax. Sudan, Nigeria, Yamen, Pakistan, and India are the top five countries contributing to malaria cases in Makkah. Weekly malaria case analyses revealed that COVID-19-related travel restrictions resulted in zero malaria cases in Makkah, indicating the magnitude of the travel-related malaria burden in the city. Full article