Late recrudescence of Plasmodium falciparum malaria in a pregnant woman: a case report

More than 90% of imported Plasmodium falciparum malaria infections are diagnosed within five weeks after returning from an endemic area. Here a case of P. falciparum malaria in a pregnant woman is reported diagnosed four years after her last stay in an endemic area. A pregnant 29-year-old Ghanaian woman having lived in Italy for eight years was seen in November 2001. Her last visit to Ghana had been in summer 1997 and she had not taken anti-malarial prophylaxis and remained apyrexial during the following months. In August 2001 she developed fever headache and vomiting initially interpreted as gravidic hyperemesis. The thick and thin blood films showed trophozoites and gametocytes of P. falciparum (PF) (5350 trophozoites x 10/6/L). A PCR was not carried out but a rapid antigen detection test (Binax NOWW ICT Pf/Pv test) and the anti-PF antibody test (IFAT BioMe´rieux) were positive (> 1/1280 versus 1/ 20 normal). The microscopy was confirmed by two referral centres in Italy and by the Prince Leopold Institute of Tropical Medicine in Antwerp Belgium. (excerpt)