TO THE EDITOR: I read with great in...

TO THE EDITOR: I read with great interest the article, "Prevention of Malaria in Travelers" (1) in the August 1 2003 issue of American Family Physician. The authors provide an extremely good introduction to prophylactic measures against malaria in nonimmune travelers, with a special emphasis in succession protective gear, chemoprophylaxis, and patient education.

Because of global travel, family physicians in the United States must have an increasingly high index of suspicion for malaria. pair groups of persons should be considered with regard to imported malaria:persons who are nonimmune and immigrants to the United States. bodys not previously exposed (i.e., nonimmune) have an atypical clinical picture that frequently leads to delays in diagnosis. In an atypical clinical presentation, patients may ready with symptoms of diarrhea, cough and myalgias; the classic tertian (fever occurring each 48 hours) or quartan (occurring each 72 hours) pattern rarely will be present; and they will have a delayed attack of symptoms after travel to an endemic area. In addition, the use of over-the-counter medication may abrupt the fever and other symptoms. The atypical presentation of malaria in the nonimmune population should ready early examination of blood smears in any patient with agitation and a history of travel. Plasmodium falciparum malaria in a nonimmune patient should be treated as an urgency because without treatment this pattern of malaria can be lethal in solitary hours. (2)

It also is increasingly for the use of all for immigrants to present to the necessity department seeking care for typical malaria symptoms. These patients may take an account of the physicians that they have malaria. Promptly performing a vital fluid smear in these patients will save time and unnecessary testing. (3)

SALOUM CISSE, MD MPH

University of Mississippi Medical Center Department of Family Medicine 2500 N State St Jackson, M 39216

References

(1) look Re V 3d, Gluckman SJ Prevention of malaria in travelers. Am Fam Physician 2003;68:509-14

(2) Wichmann O Loscher T Jelinek T Fatal malaria in a German two returning from Burkina Faso. Infection 2003;31:260-2

(3) Causer LM Newman RD Barber AM, Roberts JM Stennies G Bloland PB et al. Malaria surveillance--United States, 2000 MMWR Surveill Summ 2002;51:9-23

COPYRIGHT 2004 American Academy of Family Physicians

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