Case report: A cluster of plasmodium falciparum malaria cases among Thai workers in Gembu, Nigeria

Abstract

© Copyright 2018 by The American Society of Tropical Medicine and Hygiene. Although falciparum malaria is an important risk among travelers to sub-Saharan Africa, many travelers remain unawareofthis risk. In October 2015, wefounda cluster ofimported Plasmodium falciparum malaria cases among Thai gem mine workers in Nigeria; none had received malaria chemoprophylaxis orinformation regarding malaria risk. The index case developed fever and visited our hospital onarrival dayin Thailand after his 3-week stayin Nigeria. Plasmodium falciparum was found in his blood. He recovered completely 3 days post-admission. After we requested he contact his colleagues in Nigeria regarding malaria risk, we found that three of his five colleagues currently had fever, were diagnosed with malaria, and werebeing treatedinalocal hospital. Two were successfully treated in Nigeria. Although their bloodfilms were negative for malaria, we could confirm that they recently had malaria because the polymerase chain reaction (PCR) was still positive for P. falciparum. Tragically, the last febrile case died in Nigeria 6 days post-admission, after developing jaundice and alteration of consciousness. The two colleagues without fever symptoms were also tested by PCR, which was negative for malaria. In conclusion, we found that four of six workers had malaria in this cluster, which was equal to 66.7% attack rate. There is an urgent need to raise awareness of malaria among workers in highly endemic areas. Clinical practice for travelers who are ill on their return should not only focus on individual cases but also consider potential disease clusters.