478

White, N. J., Miller, K. D., Churchill, F. C., Berry, C., Brown, J:, Williams, S. R. & Greenwood, B. M. (1988). Chloroqume treatment of severe malaria in children. Pharma- cokinetics, toxicity and new dosage recommendations. New EnglandJournal of Medicine, 319, 1493-1500.

WHO (1986). WHO Expert Committee on Malaria; Eighteenth

Report. Geneva: World Health Organization, Technical Re- port Series, no. 735, pp. 58-64.

Received 29 August 1991; revised 23 January 1992; accepted for publication 12 February 1992

TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE (1992) 86, 478

IShort Report 1

Autochtonous Plasmodium falciparum malaria in southern France

Pierre Marty’, Yves Le Fichoux, Mohand Arezki IS, Michel Mora3, Marielle Mora3, Bernard Mathieu3 and Philippe Vessaud” Dbpartement de Parasitologic, Hbpital Cimiez, Bofte Postale 179? 06003 Nice cgdex, France; zD6partement de Parasitologze, Hiipital Avicenne, Bobigny, France; 3Hapital Civil, Frt?jus, France; 4Frkjus, France

We report here a case of Plasmodium falciparum mala- ria in a 70 years old man who had never previously travelled in any endemic area.

Mr G., born in 1921 in Piemont (northern Italy), lives in Frejus (Departement of Var, southern France). Ex- cept for occasional visits to the Piemont area, where ma- laria is unknown, the last being in September 1988, he has never left the FrCjus suburb where he works as a farmer. He has had no previous significant medical or surgical history.

On 27 August 1991 the patient suddenly complained of severe weakness, with general malaise, chills and diar- rhoea. Three days later he was admitted in emergency in a severe condition with high fever (40” C), abdominal pain, and disturbed consciousness with marked confu- sion related to an encephalopathy. Laboratory find- ings revealed mild anaemia (haemoglobin 10.6g/lOO ml), significant unconjugated hyperbilirubinaemia (119 mmol/litre), and severe thrombocytopenia (16~ lo9 per litre). Blood smear examination showed the presence of Plasmodium falciparum trophozoites in about 7% of the erythrocytes. The blood film examination was repeated several times and confirmed the diagnosis. Consequently the patient was treated with 8 mgikg mefloquine every 8 h during 16 h. Treatment led to rapid improvement and recovery was confirmed by a negative blood smear.

The route of infection remains mysterious. ‘Airport malaria’ (GIACOMINI et al., 1988; ISAACSON, 1989) is ex- cluded as the nearest international airport is 60 km away, as are also transfusion or accidental malaria infec- tion (CAROSI et al., 1986).

Entomological investigation carried out from 6-10 September 1991 in a l-3 km radius around the patient’s home did not reveal any Anopheles larvae or adults. We cannot eliminate completely the presence of a local human carrier, and Anopheles may evade even a meticu- lous entomological investigation. Another non-excluded hypothesis is that an infected Anopheles was imported in the luggage of a traveller returning from an endemic country (REVEL et al., 1988; RIZZO et al., 1989). Near to Mr G.‘s home there is a camping ground and a military camp, the inhabitants of which may have carried in their luggage infected Anopheles from endemic areas.

In circumstances like these, in a non-endemic area, di- agnosis is particularly difficult, and in this case only the blood film examination, made on haematological grounds (thrombocytopenia), resulted in the diagnosis of perni- cious malaria due to P. falciparum.

References Carosi, G., Maccabruni, A., Castelli, F. & Viale, P. (1986). Ac-

cidental and transfusion malaria in Italy. Transactions of the Royal Society of Tropical Medicine and Hygiene, g&667-668.

Giacomini, T., Toledano, D. & Baledent, F. (1988). Gravite du paludisme des a&oports. Bulletin de la SociCd de Pathologic Exotique, 81,345-350.

Isaacson, M. (1989). Airport malaria: a review. Bulletin of the World Health Organization, 67,737-743.

Revel, M. I’., Datry, A,., Saint-Raimond, A., Lenoif, G., Danis,, M. & Gent&u, M. (1988). Plasmodium falclpa?m malaria after three years in a non-endemic area. Transactzons of the Royal Society of Tropical Medicine and Hygiene, 82, 832.

Rizzo, F., Morandi, N., Riccio, G., Ghiazza, G. & Garavelli, I’. i\95p!).6Unusual transmission of malaria in Italy. Lance& i,

Received 10 March 1992; revised 22 April 1992; accepted for publication 23 April I992

Third Conference on International Travel Medicine 26-29 April 1993; Paris, France

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