A case from Aarhus, Denmark reported to GeoSentinel® by Carsten Schade Larsen and a recent cluster of Plasmodium falciparum cases in six SWISS International Airline crew members after brief stays of 1-2 nights, in May 2017, highlight the risk of falciparum malaria in urban Dar es Salaam. Danish Case: In the period 28 January to 5 February 2017, a Danish engineer, traveled to Dar es Salaam from Chennai, India, where he lives and works. He did not travel outside the city. He flew back to India, but travelled to Austria on 11 February for a skiing holiday meeting his brother and a friend from Denmark. On the 15th of February, he started to feel ill with fever and back pain. Three days later, Saturday 18 February, he was seen by a local general physician due to fever, increasing headache and vomiting, and was diagnosed with influenza A. After return to Denmark and a total of 4 physician encounters and missed malaria diagnosis, he was hospitalized. His temperature was 41.1 0C with C-reactive protein = 59.3 mg/l, hemoglobin = 5.9 mmol/l, leucocytes = 1.95 x 109/l, platelets = 39 x 109/l, lactate = 5.2 mmol/l, ALAT = 224 U/l and LDH = 495 U/l. A malaria rapid diagnostic test was positive and the patient was transferred to the Department of Infectious Diseases, Aarhus University hospital. Malaria smear showed P. falciparum with 7 % parasitemia. The patient was treated with IV artesunate followed by oral artemether-lumefantrine and had an uneventful recovery. Two weeks later he travelled home to India. At that time, his hemoglobin was 6.1 mmol/l and blood samples did not show any hemolysis. Cluster of cases in SWISS International Airline Crew: The crew members acquired their Pf malaria during brief 1-2 night lay over in urban Dar-es-Salaam in the period May 1st to May 29th, 2017. The heavy rains in this area may have contributed to the increased risk of malaria transmission. More details to follow. These cases have implications for air crews and other travelers who stay in urban areas of malaria endemic countries in sub-Saharan Africa. Chemoprophylaxis and meticulous anti-mosquito measures are recommended for mainland Tanzania including Dar es Salaam. Please be alert to fever in travellers returning from this area including those with brief urban sojourns.
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A case from Aarhus, Denmark reported to GeoSentinel® by Carsten Schade Larsen and a recent cluster of Plasmodium falciparum cases in six SWISS International Airline crew members after brief stays of 1-2 nights, in May 2017, highlight the risk of falciparum malaria in urban Dar es Salaam. Danish Case: In the period 28 January to 5 February 2017, a Danish engineer, traveled to Dar es Salaam from Chennai, India, where he lives and works. He did not travel outside the city. He flew back to India, but travelled to Austria on 11 February for a skiing holiday meeting his brother and a friend from Denmark. On the 15th of February, he started to feel ill with fever and back pain. Three days later, Saturday 18 February, he was seen by a local general physician due to fever, increasing headache and vomiting, and was diagnosed with influenza A. After return to Denmark and a total of 4 physician encounters and missed malaria diagnosis, he was hospitalized. His temperature was 41.1 0C with C-reactive protein = 59.3 mg/l, hemoglobin = 5.9 mmol/l, leucocytes = 1.95 x 109/l, platelets = 39 x 109/l, lactate = 5.2 mmol/l, ALAT = 224 U/l and LDH = 495 U/l. A malaria rapid diagnostic test was positive and the patient was transferred to the Department of Infectious Diseases, Aarhus University hospital. Malaria smear showed P. falciparum with 7 % parasitemia. The patient was treated with IV artesunate followed by oral artemether-lumefantrine and had an uneventful recovery. Two weeks later he travelled home to India. At that time, his hemoglobin was 6.1 mmol/l and blood samples did not show any hemolysis. Cluster of cases in SWISS International Airline Crew: The crew members acquired their Pf malaria during brief 1-2 night lay over in urban Dar-es-Salaam in the period May 1st to May 29th, 2017. The heavy rains in this area may have contributed to the increased risk of malaria transmission. More details to follow. These cases have implications for air crews and other travelers who stay in urban areas of malaria endemic countries in sub-Saharan Africa. Chemoprophylaxis and meticulous anti-mosquito measures are recommended for mainland Tanzania including Dar es Salaam. Please be alert to fever in travellers returning from this area including those with brief urban sojourns.