Abstract
In malaria elimination areas, malaria cases are sporadic and consist predominantly of imported cases. Plasmodium knowlesi cases have been reported throughout Southeast Asia where long-tailed and pig-tailed macaques and Anopheles leucosphyrus group mosquitoes are sympatric. The limitation of microscopic examination to diagnose P. knowlesi is well known. In consequence, no P. knowlesi case has previously been reported from routine health facility-based case finding activities in Indonesia. This report describes two clusters of unexpected locally acquired P. knowlesi cases found in an area where Plasmodium falciparum and Plasmodium vivax infection had been eliminated in Sabang Municipality, Aceh, Indonesia. The difficulties in diagnosis and response illustrate challenges that Southeast Asian countries will increasingly face as the formerly common malaria parasites P. falciparum and P. vivax are gradually eliminated from the region.
Highlights
As a result of universal coverage of long-lasting insecticide-treated bed nets (LLINs), indoor residual house spraying (IRS), early diagnosis by microscopy, and radical treatment using artemisinin combination therapy (ACT) and primaquine (PQ), the number of malaria cases has markedly declined throughout Indonesia [1]
The cases were originally identified via microscopy as Plasmodium malariae and P. vivax, case investigation raised suspicion that Plasmodium knowlesi might be involved, leading to subsequent polymerase chain reaction (PCR) diagnosis and confirmation that 15 of the cases were P. knowlesi infections, with two patients declining to provide blood for diagnosis, and one negative
A 28-year old man (S) visited Primary Health Centre (PHC) Sukakarya on 3 January, 2014 with fever, chill, nausea, vomiting, and headache for 2 weeks after he arrived in Sabang from Bireun District, Aceh, which is not known to be endemic for malaria [7]
Summary
As a result of universal coverage of long-lasting insecticide-treated bed nets (LLINs), indoor residual house spraying (IRS), early diagnosis by microscopy, and radical treatment using artemisinin combination therapy (ACT) and primaquine (PQ), the number of malaria cases has markedly declined throughout Indonesia [1]. A 28-year old man (S) visited Primary Health Centre (PHC) Sukakarya on 3 January, 2014 with fever, chill, nausea, vomiting, and headache for 2 weeks after he arrived in Sabang from Bireun District, Aceh, which is not known to be endemic for malaria [7]. He arrived Sabang during the third week of December 2013, where he worked at a construction site in Kuta Timur village, Sabang. Chill, vomiting, Batee Shok PCD headache, nausea, unconsciousnessa, haemoglobinuria
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