Abstract
BackgroundThailand is a major destination for German travellers with more than 760,000 arrivals in 2015. At the same time, malaria is a concern in travel recommendations with regard to this destination. The World Malaria Report of 2016 mentions only P. falciparum and P. vivax as prevalent species for Thailand, however, P. knowlesi infections have been occasionally reported in Thailand. In German travellers, only five cases of P. knowlesi infections have been reported to date.Case presentationA 45-year-old German male tourist travelled to Thailand from 25 December 2016 to 13 January 2017. On 14 January he developed fever with no other symptoms, and presented on 17 January at the Division for Tropical Medicine and Infectious Diseases in Munich, Germany.Malaria was diagnosed, primarily based on a single parasite in the thin smear microscopy, while commercial rapid diagnostic testing remained negative. Only the result of a differential PCR assay revealed P. knowlesi infection.ConclusionsP. knowlesi has to be considered in travellers returning from Thailand. Cases may present with an extremely low parasitaemia. This is in contrast to the assumption that P. knowlesi was likely to cause high parasitaemia due to its short replication cycle.
Highlights
Thailand is a major destination for German travellers with more than 760,000 arrivals in 2015
P. knowlesi has to be considered in travellers returning from Thailand
Cases may present with an extremely low parasitaemia. This is in contrast to the assumption that P. knowlesi was likely to cause high parasitaemia due to its short replication cycle
Summary
Despite considerable reductions in morbidity, malaria remains to be a relevant public health concern for Southeast Asia. The incidence of malaria across all Plasmodium species in travellers to Thailand from 12 European countries and the USA has been reported by Behrens et al at 0.60 cases per 100,000 visits for the year 2008 [8]. In German travellers returning from Southeast Asia, P. knowlesi infections are analogously considered very rare events. This article is presenting a further case of a P. knowlesi infection in a returning German traveller from Thailand, and highlights the difficulties in accomplishing the correct diagnosis. Regular use of repellents and of bed nets was reported He did not reveal a medical history indicative of previous malaria infections. On 14 January, the day after his return to Germany, he started to feel chills and developed fever up to 40 °C He developed profuse sweating, at night time. A full blood sample was sent to the national reference laboratory for PCR-based malaria differentiation at the Bernhard-Nocht-Institute for Tropical Medicine (BNITM), Hamburg, Germany
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