Canadian children who travel abroad: What are the risks?

Afive-year-old boy travelled with his family to Kenya to visit his grandparents. Two years before he was born, his parents had emigrated from Kenya. This was his first visit to the family’s home country where they spent time in Nairobi and also travelled ‘up-country’ to visit extended family. No pretravel advice was obtained; however, the boy’s routine immunizations were up to date. He was well during his trip, but one week after his return to Canada, he complained of headaches and abdominal pain that were associated with a body temperature of 39.5°C. Two days later, he presented to his paediatrician’s office with persistent fever. He had vomited once, but had no diarrhea. He had no upper respiratory symptoms and no evidence of rash. His mother said that he was not eating and was sleeping more than usual. On examination, he was noted to be sleepy but rousable; his examination was unremarkable, apart from a heart rate of 120 beats/min. His complete blood count revealed a white blood cell count of 7.8×10 9 /L, a hemoglobin level of 72 g/L and a platelet count of 82×10 9 /L. His liver enzymes were slightly elevated, but his renal function and glucose were normal. His malaria smear revealed 2% parasitemia with Plasmodium falciparum. He was admitted to hospital and initially treated with intravenous quinine and clindamycin, followed by oral atovaquone-proguanil, and he made a full recovery.