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“We report a case of falciparum malaria in a traveler 9 days after successful treatment of ovale malaria. The underlying, cryptic mixed-species infection was primarily undetectable with standard laboratory diagnostics. This case highlights the limitations of these tests and the unpredictability of typical incubation periods in the individual case. The number of imported malaria cases in the WHO European region has declined in recent years

but still amounts to several thousand episodes annually. According to the GeoSentinel analysis of data from international travelers from 1997 to 2002, 74% of imported malaria infections were acquired in sub-Saharan Africa. Travelers visiting friends and relatives (VFRs) made up the biggest proportion (35%) of imported cases, were less likely than others to receive pre-travel counseling

AZD2281 cost Etoposide mouse from a health care provider, and often did not take antimalarial chemoprophylaxis. Only 2.1% of imported malaria infections were mixed species, but 90% of those involved potentially fatal Plasmodium falciparum. The typical interval between returning from travel and presentation to a health care provider was 7 to 14 days for P falciparum and 2 to 6 months for Plasmodium ovale.1 We report a case of a traveler VFR, who did not take antimalarial chemoprophylaxis and developed P falciparum malaria 9 days after a successfully treated first malaria episode with P ovale. A 58-year-old man of Nigerian origin, living in Germany for 37 years, presented to the outpatient clinic of the Institute of Tropical Medicine and International Health in Berlin. He reported a 3-day history of fever and chills. Four days before that, he had returned from a 3-week visit to Lagos, Nigeria, where he had not taken antimalarial chemoprophylaxis. At presentation, he was afebrile and in good clinical condition. The laboratory tests showed

normal values for hemoglobin, white blood cell (WBC) and platelet counts, liver enzymes, clonidine bilirubin, lactate dehydrogenase, and creatinine. The C-reactive protein (CRP) was increased at 14.7 mg/L (normal value <5 mg/L). Dengue fever was ruled out by negative NS1-antigen test. Thick and thin blood films revealed the presence of P ovale (parasite density, <0.01%) but no other malaria parasites were detected. The immunochromatographic test (ICT, Binax NOW; Binax, Inc., Scarborough, ME, USA) was negative for P falciparum-specific histidine-rich protein-2 (HRP-2) and the pan-malarial aldolase antigen. Because of the diagnosis of ovale malaria, the patient was treated with chloroquine (25 mg/kg body weight). Two days later, the patient’s condition had improved. Blood films and ICT were negative. Apart from a WBC of 3.1 G/L, and a raised CRP (34.8 mg/L), all other laboratory parameters were normal.