Abstract
BackgroundPlasmodium ovale is responsible for 5% of imported malaria in French travellers. The clinical and biological features of six clustered cases of P. ovale malaria in an army unit of 62 French soldiers returning from the Ivory Coast are reported.Case reportAll patients were symptomatic and developed symptoms on average 50 days after their return and 20 days after the end of chemoprophylaxis (doxycycline). Clinical features included fever (6/6), mostly tertian (4/6), aches (6/6), nausea (3/6), abdominal pain (2/6), diarrhoea (2/6), or cough (2/6). Thrombocytopaenia was lower than 100,000/mm3 in half the cases only, and the haemoglobin count was normal for all patients. The diagnosis was made after at least three thick and thin blood smear searches. Parasitaemia was always lower than 0.5%. All rapid diagnostic tests were negative for HRP2 and pLDH antigens.DiscussionPlasmodium ovale malaria is currently a problem to diagnose in travellers, notably in French soldiers returning from the Ivory Coast. Early attempts at diagnosis are difficult due to the lack of specific clinical features, the rarity of biological changes and the poor sensitivity of diagnostic tools to detect low parasitaemia. Thus, the diagnosis is commonly delayed or missed. Physicians should be aware of this diagnostic challenge to avoid relapses and provide prompt and adequate treatment with chloroquine and radical cure with primaquine.
Highlights
Plasmodium ovale is responsible for 5% of imported malaria in French travellers
Plasmodium ovale malaria is currently a problem to diagnose in travellers, notably in French soldiers returning from the Ivory Coast
For travellers, P. falciparum is the main target of malarial prevention because this species is widely endemic, very common and clinically severe [1]
Summary
P. falciparum is the main target of malarial prevention because this species is widely endemic, very common and clinically severe [1]. All available rapid antigenic tests currently lack sensitivity to P. ovale, while they are highly sensitive to P. falciparum [13,14,15] They generally fail to detect P. ovale infection when thick films and blood smears are negative. Considering the high sensitivity and specificity of molecular detection of P. ovale using PCR, this tool marks real progress in confirming the diagnosis, it is still not routinely available [5,7,16] It can be used as a second-line diagnosis tool to identify infra-microscopic parasitaemia, especially for unexplained relapsing fever in travellers. To date, diagnosing P. ovale infection in travellers returning from endemic areas is still a challenge for physicians and requires repeat microscopic searches to detect low parasitaemia. Competing interests The authors declare that they have no competing interests
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