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The number of malaria cases diagnosed in the United States rose to a peak of 4,545 in 1970 and has since begun to decline. From 1963 to 1972 42 deaths were reported, of which 37 were due to Plasmodium falciparum malaria. Hospital type-specific case-fatality ratios could be calculated for the period January 1966 to June 1972; persons treated in civilian facilities in this period had a fatality ratio 24 times that for persons treated by military or Veterans Administration physicians. This difference in mortality may be related to the significantly longer delay between first patient examination and diagnosis of malaria in civilian facilities. Histories of three fatal malaria cases are presented which illustrate the complication of splenic rupture in malaria, the predisposing effect of prior splenectomy, and the occurrence of malaria in the high-risk group of merchant seamen. Certain aspects of the presentation of malaria critical to its early clinical diagnosis are discussed.
Epidemic Intelligence Service Officer, Parasitic Diseases Branch, Bureau of Epidemiology, CDC, Atlanta. Currently Research Associate, Rockefeller University, New York, N. Y.
Epidemic Intelligence Service Officer, Parasitic Diseases Branch, Bureau of Epidemiology, CDC.
Chief, Parasitic Diseases Branch, Bureau of Epidemiology, CDC, Atlanta.