Abstract
Malaria was rampant in Sri Lanka two decades ago but we have since been declared free of malaria transmission by the WHO in 2016. However, neighboring India still has a high incidence of malaria, and visitors to India carry a high risk of contracting this disease. Despite the elimination of indigenous cases of malaria in Sri Lanka, a fair number of cases are detected from travelers coming from endemic regions of the globe. Delay in diagnosis occurs due to a lack of awareness among the medical community and a missed travel history as observed in this case scenario. We report a 71-year-old previously healthy Sri Lankan male who developed a febrile illness after sixteen days of traveling in India on pilgrimage. He presented with a six day history of of illness and it took a further seven days to consider malaria as a possible diagnosis. Malaria antigen was positive on day thirteen of the illness with Plasmodium vivax trophozoites and gametocytes seen on the thick and thin films. He was treated with chloroquine and recovered slowly with clearing of parasitaemia. A correct diagnosis and close liaison with the anti-malaria campaign helped in the successful management of our patient. This report is an eye opener to consider malaria as a diagnostic possibility and a clinical dilemma and to take a detailed travel history in patients presenting fever. Raising awareness of travelers about prevention against malaria and the need for malaria prophylaxis is also necessary.
Highlights
Malaria is considered the most infectious parasitic disease in humans
It is estimated that the highest number of P. vivax cases worldwide is reported from India, the majority of the falciparum malaria cases are reported from the other territories mentioned above
We describe a case of imported P. vivax malaria from India
Summary
Malaria is considered the most infectious parasitic disease in humans. Sri Lanka, an island to the southeast of India in the Indian Ocean has an interesting history with regard to the battle against malaria. A 71-year-old previously healthy male, a retired government officer residing in Peradeniya in the Central Province of Sri Lanka was admitted to Teaching Hospital Peradeniya (THP) on September 1st, 2018 with a history of fever of 6 days. This patient has been on a pilgrimage to India with a team of thirty-six members on 8th August 2018. The patient was given adequate supportive care including hydration and offered antibiotic cover with oral levofloxacin for a total of five days for the cough He was discharged on September 10th when parasitemia was not detectable with follow up care arranged in liaison with the anti-malaria campaign. Started treatment in First medical contact liaison with antiin Sri Lanka malaria campaign
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