Abstract
A case of autochthonous Plasmodium vivax malaria with sub-microscopic parasitaemia and polyclonal B-cell activation (PBA) (as reflected by positive IgM and IgG serology for toxoplasmosis, cytomegalovirus, and antinuclear and rheumatoid factors) was diagnosed by polymerase chain reaction (PCR) after consecutive negative rapid diagnostic test results and blood films. The patient, a 44-year-old man from Rio de Janeiro state, Brazil, had visited the Atlantic Forest, a tourist, non-malaria-endemic area where no autochthonous cases of ’bromeliad malaria‘ has ever been described. The characteristic pattern of fever, associated with PBA, was the clue to malaria diagnosis, despite consecutive negative thick blood smears. The study highlights a need for changes in clinical and laboratory diagnostic approaches, namely the incorporation of PCR as part of the current routine malaria diagnostic methods in non-endemic areas.
Highlights
Malaria is a potentially fatal disease, especially for individuals exposed for the first time
The extra-Amazonian region is considered a non-endemic area for malaria, autochthonous cases known as the "bromeliad-malaria" are reported in areas inside or near the Atlantic Forest, which provides an excellent environment for Anopheles (Kerteszia) bellator and Anopheles (Kerteszia) cruzii that can transmit Plasmodium and use the water collection in bromeliad to their breeding and larval habitat [5,6]
The patient described here did not visit the Amazon region, which accounts for 99.8% of registered malaria cases in Brazil [2], and had not travelled outside Brazil on any occasion, nor had any previous experience of epidemiological conditions associated with malaria, such as transfusional, nosocomial or airport malaria
Summary
Malaria is a potentially fatal disease, especially for individuals exposed for the first time. The patient had no co-morbid diseases or any history of blood transfusion, tissue/organ transplantation, intravenous drug use, or travel to a malaria-endemic area He had not been injured by needle sticks, nor lived or recreated near ports or airports. He had not experienced high fevers in the years prior to this event, and he had not taken drugs with anti-malarial activity either prior to or after the onset of the disease During physical examination, his body temperature was 39°C, his blood pressure was 110/60 mmHg, and his pulse rate was 93 beats per minute. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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