Bronchospasm after scuba diving

To the Editor: We report a case of malaria acquired by an Australian tourist in Bali, where the risk of malaria is low.l ,2 A 21-year-old previously well Australian man travelled to Bali for a 10-day holiday. He stayed in a five-star resort in Nusa Dua and made several daytrips by motorbike. He recalled several mosquito bites. He did not travel to Lombok or other surrounding islands. He had never previously travelled out of Victoria, Australia. His antimalarial medication consisted of two chloroquine tablets per week (300mg base chloroquine), starting two weeks before travel and concluding three weeks after return. He missed one dose of chloroquine while in Bali. He presented six weeks after returning having had three weeks of fever and myalgia. Blood films showed Plasmodium vivax. He responded well to standard therapy with chloroquine and primaquine. Malaria risk in Bali is regarded as being very low, particularly in the main resort areas. 1,2 As a result, many travellers to Bali do not take antimalarial prophylaxis. However, a survey of blood parasites in 284 Balinese people showed three cases of Plasmodium vivax and two cases of Plasmodium falciparum » indicating that a malaria risk still exists. Although chloroquine-resistant Plasmodium vivax has occurred elsewhere in Indonesia,s our patient's infection was unlikely to have been chloroquine-resistant, given his poor compliance with medication and rapid complete recovery after therapy with chloroquine and primaquine. Short-term visitors to Bali need not be given antimalarial prophylaxis unless travelling to surrounding islands such as Lombok, where the risk of malaria is high. Nevertheless, malaria should be considered when diagnosing febrile illnesses in patients who have been to Bali.