Plasmodium ovale Malaria in Travelers and Immigrants to the United States: A Case Series

Jonathan A. Mayhew Ryan White Center for Global Health and Pediatric Infectious Diseases, Indiana University, Indianapolis, Indiana;
Department of Pediatric & Adolescent Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan

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Muayad Alali Ryan White Center for Global Health and Pediatric Infectious Diseases, Indiana University, Indianapolis, Indiana;

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Leslie A. Enane Ryan White Center for Global Health and Pediatric Infectious Diseases, Indiana University, Indianapolis, Indiana;

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Lindsey M. Kirkpatrick Ryan White Center for Global Health and Pediatric Infectious Diseases, Indiana University, Indianapolis, Indiana;

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Chandy C. John Ryan White Center for Global Health and Pediatric Infectious Diseases, Indiana University, Indianapolis, Indiana;

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ABSTRACT.

Malaria in child travelers caused by Plasmodium ovale spp. is less well characterized than malaria due to other Plasmodium species. Commonly used diagnostic tests often lack adequate sensitivity to identify P. ovale spp., and a missed diagnosis may have serious consequences. We present a case series of eight children in the United States with P. ovale malaria, all of whom had traveled to or immigrated from malaria-endemic areas. Two children developed clinical malaria, including one with severe malaria; two had isolated splenomegaly; and four were asymptomatic siblings of the children with splenomegaly. Seven of the eight children had negative blood smear readings, and the diagnosis was made by polymerase chain reaction testing. Two children had concurrent P. malariae infection despite presumptive antimalarial treatment before immigration. These findings suggest a need for reconsideration of screening and diagnostic evaluation for P. ovale malaria in high-risk groups.

Author Notes

Financial support: This work was supported by the Indiana University Immunology and Infectious Disease Training Program T32 (NIH AI060519) to J. A. Mayhew and the Pediatric Infectious Diseases Society Fellowship Award funded by Stanley and Susan Plotkin and Sanofi to J. A. Mayhew. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Current contact information: Jonathan A. Mayhew, Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine, Kalamazoo, MI, E-mail: jonathan.mayhew@wmed.edu. Muayad Alali, Leslie A. Enane, Lindsey M. Kirkpatrick, and Chandy C. John, Ryan White Center for Global Health and Pediatric Infectious Diseases, Indiana University, Indianapolis, IN, E-mails: mualali@iu.edu, lenane@iu.edu, e-lkirkpat@iu.edu, and chjohn@iu.edu.

Address correspondence to Jonathan A. Mayhew, 1000 Oakland Dr, Kalamazoo, MI 49008. E-mail: jonathan.mayhew@wmed.edu
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