Abstract
Following progressive reduction in confirmed cases of malaria from 2002 to 2007 (41,411 cases in 2002, 10,510 cases in 2003, 3,720 cases in 2004, 1,640 cases in 2005, 591 cases in 2006, and 198 cases in 2007). Sri Lanka entered the pre-elimination stage of malaria in 2008. One case of indigenous malaria and four other cases of imported malaria are highlighted here, as the only patients who presented to the Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka over the past eight years, in contrast to treating several patients a week about a decade ago. Therefore, at the eve of elimination of malaria from Sri Lanka, it is likely that the infection is mostly encountered among travellers who return from endemic areas, or among the military who serve in un-cleared areas of Northern Sri Lanka. They may act as potential sources of introducing malaria as until malaria eradication is carried out. These cases highlight that change in the symptomatology, forgetfulness regarding malaria as a cause of acute febrile illness and deterioration of the competency of microscopists as a consequence of the low disease incidence, which are all likely to contribute to the delay in the diagnosis. The importance regarding awareness of new malaria treatment regimens, treatment under direct observation, prompt notification of suspected or diagnosed cases of malaria and avoiding blind use of anti-malarials are among the other responsibilities expected of all clinicians who manage patients in countries reaching malaria elimination.
Highlights
The history of malaria in Sri Lanka dates back to the ancient kingdoms
The first case was unexpected in southern Sri Lanka which is considered non-endemic for malaria
Infection is mostly encountered among travellers who return from endemic areas such as African countries and from India, or among military personnel serving in the northeast of the country
Summary
The history of malaria in Sri Lanka dates back to the ancient kingdoms. During the long documented history of malaria in Sri Lanka several major epidemics were experienced. Colombo suburbs; an area which is endemic for dengue He was suspected to be suffering from dengue fever, but was detected to be having Plasmodium vivax malaria on a routine blood film. He was successfully treated with chloroquine and a 14-day course of primaquine, ensuring clearance of malaria parasites by repeated parasite counts (Table 1). Case 3 In December 2009, a 36-year-old Sri Lankan male employed in Uganda presented with severe pallor and 5 cm firm splenomegaly (Table 1) He had returned to the island about a month before due to feeling “lethargic”. They were detected to have P. vivax malaria on routine blood films and responded to anti-malarials chloroquine followed by 14-day primaquine. Ethical permission Ethical permission to publish clinical details of patient was obtained from the Ethics
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