IV Balearic Meeting of European Residents and GP of IBAMFIC

The GP as an Educator for Travelers on ChemoprophylaxisFÓTHY, Julio Francisco; CONDE-VALVIS FRAGA, Sara

MeSH Keywords: Chemoprophylaxis, Endemic, Malaria- 35-year-old male, native from Ghana, living in Europe for the last 7 years returns from his country.- Made a Chloroquine chemoprophylaxis, finishing early 2 weeks before coming back.- 2 weeks after arriving he starts with nausea (no vomiting), anorexia, headache and high temperature with shivering.

Physical examination:- Temp 38.2°C - Respiratory auscultation: NAD- HR 98 bpm - Normal abdomen: No hepatosplenomegaly- BP 126/77 mmHg - No Lymphadeneopathy- Overall preserved.

Malaria is suspecteReferred to A&E:- Thick blood film with Giemsa: 1.5% parasitized red blood cells.- Antigen chromatography: Plasmodium falciparum vs. mixer infection.- Full Blood Count, coagulation, renal function, urinalysis and electrolytes normal- Gluc 120mg/dl, CPR 38.80mg/l; Lactate 0.92mmol/l; Total Bilirubin 2.44mg/dl; Direct Bilir 0.88mg/dl, ASAT 43; ALAT 61, GGT 80, alkaline

phosphatase 50U/LDischarged the following day. Home treatment:- Quinine sulfate 650 mg TDS + Doxycycline 100 mg BD for 7 days.

Conclusions:- It is important to know that, because of its high resistance rate, chemoprophylaxis of choice for some Plasmodium falciparum endemicareas (such as the exposed case) is NOT chloroquine (Resochin ®) but atovaquone 250mg+proguanil 100 mg (Malarone ®) or artenimol40mg+piperaquine 320mg (Eurartesim ®) among others.

- It is essential to explain the importance of chemoprophylaxis to travelers to endemic areas: A complete course of chemoprophylaxismust be assured (pre-, intra- and post-traveling), which should be stocked up before the trip starts. So the quality of the treatment isassured and the purchase of circulating false drugs in endemic areas is also avoided.

- If chemoprophylaxis is rejected or there are contraindications there is the exceptional possibility of self-administered treatment, asrescue on clinical suspicion, until professional health assistance is reached, with Malarone ® or Eurartesim ® among others, both availablein Europe.