Difficulties in Diagnosis of Malaria in Non-Endemic Areas: A Case Report of a Child in Brazil

Yvone Maia Brustoloni,Fernanda Maia Brustoloni,Pamela Mantovani Baldissera

doi:10.4172/2470-6965.1000132

Yvone Maia Brustoloni, Fernanda Maia Brustoloni + Show 1 more

Open Access

https://doi.org/10.4172/2470-6965.1000132

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Abstract

Malaria is a tropical parasitic disease that triggers severe social and economic problems worldwide and causes thousands of deaths each year. Early diagnosis enables proper treatment. People from non-endemic areas who travel to areas of transmission are often exposed to late or incorrect diagnosis because healthcare professionals have great difficulty in conceiving malaria as a diagnostic hypothesis. In addition, technicians skilled in recognizing malaria etiologic agent are not abundant. This paper addresses the case of a child from a non-endemic malaria region in Brazil, with a prior hypothetic diagnosis of visceral leishmaniasis, however bone marrow aspirate revealed Plasmodium instead of Leishmania. A retrospective epidemiological investigation showed a history of a recent trip to a malaria area and the review of blood smears obtained on admission disclosed a large number of trophozoites and gametocytes of Plasmodium falciparum that had been unnoticed, suggesting that diagnosis could have been possible earlier. Malaria clinical picture is easily mistaken for other febrile infectious diseases, thus the possibility of its occurrence cannot be ruled out. There is a need to increasingly train the microscopy technicians, both in endemic and non-endemic areas, so as to minimize the false diagnoses and decrease morbidity and mortality of the disease.

Highlights

Malaria incidence and mortality rates have fallen during the past decade, its transmission still occurs in 99 countries around the world
We here describe a case of a boy residing in a non-endemic area of malaria in Brazil who had travelled to a state of the Amazon Basin, and whose diagnosis of malaria has not been hypothesized when he presented fever some days after he returned home
Malaria diagnosis was completed by the finding of trophozoites and gametocytes of Plasmodium falciparum in bone marrow aspirate

Summary

Introduction

Malaria incidence and mortality rates have fallen during the past decade, its transmission still occurs in 99 countries around the world. Malaria is still a major public health problem in Brazil, with approximately 300.000 cases registered yearly, almost exclusively (99,8%) restricted to the region of the Amazon Basin [3]. We here describe a case of a boy residing in a non-endemic area of malaria in Brazil who had travelled to a state of the Amazon Basin, and whose diagnosis of malaria has not been hypothesized when he presented fever some days after he returned home. The case here described illustrates that out of endemic areas general practitioners are much less alert to consider the diagnosis of malaria when facing a febrile patient.The objective of this report is to highlight that malaria must be considered as a potential diagnosis in diseases with intermittent fever. Lost or late diagnosis of malaria, specially caused by P. falciparum, can lead to severe outcomes

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