PB2023 SPORADIC CASES OF MALARIA IN NORTHERN GREECE, A MALARIA FREE COUNTRY

Abstract

Background:Malaria is a disease caused by protozoa of the genus Plasmodium and the main hosts are arthropods. Human transmission is preceeded by female mosquito Anopheles bite. Human pathogens are Plasmodium vivax, falciparum and malariae, Less common are Plasmodium ovale and knowlesi. Since 1974, Greece is a Malaria free country. Nevertheless, sporadic cases are reported.Aims:We report five cases of malaria admitted in a tertiary care hospital of Thessaloniki.Methods:Five patients, 15‐34 years old were admitted consecutively, in three different departments of a tertiary care hospital in northern Greece from 2/10/2018 to 10/10/2018 due to fever, fatigue and night malodorous sweats. All five patients were relatives. Two sisters, living in the same house and their cousin with her two children, living in the same residential area. None of them had recently travelled in an epidemic county or had a blood transfusion. The diagnosis was based on a peripheral blood smear which was performed due to anemia, thrombocytopenia and neutropenia reported upon admission of the first patient. Characteristic ring forms, merozoites, trophozoites inside red blood cells and gametocytes were observed. Rapid malaria test revealed non‐falciparum infection and samples for molecular diagnostic testing were collected. Molecular analysis established Plasmodium vivax infection. All patients were treated with atovaquone 250 mg/ proguanile 100 mg per os, 4 pills once a day, for three days. Patients responded promptly and continued eradication therapy with primaquine for the next 14 days. Patients follow up included weekly visits at the hospital, blood testing with FBC, peripheral blood smears and rapid malaria testing, for three consecutive weeks in order to establish Plasmodium full elimination.Results:All patients were cured without complications. Due to the severity of the disease, the Greek Center of disease control was called to locate the source of the disease and take action concerning public health.Summary/Conclusion:Given the fact that malaria is not a common diagnosis, clinicians should have a close collaboration with the laboratory, even in malaria free countries. New sporadic cases can be found due to population migration. Increased rainfall, also affects malaria transmission because it increases relative humidity, modifies temperature and affects mosquito population and is a probable cause for those five cases in Thessaloniki. All cases must be reported as soon as possible and general population should be protected. Prompt diagnosis and treatment are in favor of the patient and general population.