1- Serviço de Pediatria, Unidade Local de Saúde do Baixo Alentejo, Beja
2- Unidade de Infecciologia Pediátrica. Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- 37th Annual Meeting of the European Society for Pediatric Infectious Diseases, reunião internacional
Background: Malaria remains a major cause of disease worldwide. Diagnosis is based on clinical suspicion and detection of parasites on blood samples. P. falciparum is the responsible for most cases of severe disease.
Case Report: Previously Healthy, 5-year-old child, with alternated residence for long periods between Portugal and Angola. Observed in the emergency department for fever for three days, vomiting, cough and rhinorrhea. CBC with Hb 14.4 g/dL, WBCs 5150U/ L, Platelets 77.000/L, AST 46U/L; ALT 27U/L, CRP 11.2 mg/dL, SR 5 mm/ hr. Normal Chest radiography.Plasmodium test revealed parasitemia (<1%), with positive microscopic observation for plasmodium spp. Due to oral intolerance, he was admitted for IV quinine, and discharged after 24 hours on atovaquone/proguanil. Six months after another trip to Angola, he was again observed for fever and dehydration. Blood tests revealed Hb 12.8 g/dL, WBC’s 6150U/L, platelets 103000/L, AST 32U/L; ALT 18U/L, CRP 7.6mg/dL, SR 10 mm/h. Thick drop test showed Plasmodium trophozoites and low parasitemia (<1%). He was admitted for IV hydration and started therapy with artenimol. PCR test identified Plasmodium ovale and Primaquine was aded to the prescription. He was discharged, clinically well, with no new episodes of fever.
Comments: Optical microscopy and rapid diagnostic tests are useful for the diagnosis of the parasite, but more sensitive molecular biology methods should be performed, whenever needed. Overlap infections are common in malaria-endemic regions, and it has been suggested that treatment should be consolidated with an agent to eradicate the parasite and avoid recurrence, particularly in the case of P ovale co-infection.
Palavras Chave: Malaria, recurrence, overlap, p ovale,