Case Report: Delayed or Recurrent Plasmodium falciparum Malaria in Migrants: A Report of Three Cases with a Literature Review

Nicolas Dauby Infectious Diseases Department, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Brussels, Belgium;

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Mariana Figueiredo Ferreira Internal Medicine Department, CHU Saint-Pierre, Brussels, Belgium;

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Deborah Konopnicki Infectious Diseases Department, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Brussels, Belgium;

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Vo Thanh Phuong Nguyen Hematology Department, LHUB-ULB, Brussels, Belgium

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Brigitte Cantinieaux Hematology Department, LHUB-ULB, Brussels, Belgium

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Charlotte Martin Infectious Diseases Department, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Brussels, Belgium;

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Emerging evidence indicates that migrants from Plasmodium falciparum endemic regions are at risk of delayed presentation of P. falciparum malaria. We report three cases of P. falciparum malaria occurring years after arrival in Europe. All patients were originally from Sub-Saharan Africa. Two subjects had controlled human immunodeficiency virus infection and one was a pregnant woman. We performed a literature review of all published cases of delayed presentation of P. falciparum in migrants and identified 32 additional cases. All cases but one originate from sub-Saharan Africa. There was a median time of 36 months between the last visit to a malaria-endemic country and clinical malaria (range: 3 months to 10 years). Pregnancy was the most frequently reported risk factor (11/35 or 31.4%). Parasitemia was ≤ 0.1% in 38% of cases (11/29 reported), and no death was reported. The underlying possible mechanisms for this delayed presentation in migrants from an endemic area probably include the persistence of submicroscopic parasitemia combined with decaying P. falciparum–specific immunity. Suspicion of P. falciparum delayed malaria should remain high in migrants, mainly from sub-Saharan Africa, even without a recent travel history, especially in those presenting risk factors for impaired parasite clearance or distinct immune responses such as pregnancy and HIV infection. In these patients, new prevention and screening strategies should be studied and blood safety policies adapted.

Author Notes

Address correspondence to Nicolas Dauby, Infectious Diseases Department, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Rue Haute, 322, Brussels 1000, Belgium. E-mail: nicolas_dauby@stpierre-bru.be

Authors’ addresses: Nicolas Dauby, Deborah Konopnicki, and Charlotte Martin, Infectious Diseases Department, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Brussels, Belgium, E-mails: nicolas_dauby@stpierre-bru.be, deborah_konopnicki@stpierre-bru.be, and charlotte_martin@stpierre-bru.be. Mariana Figueiredo Ferreira, Internal Medicine Department, CHU Saint-Pierre, Brussels, Belgium, E-mail: mariana_figueiredoferreira@stpierre-bru.be. Vo Thanh Phuong Nguyen and Brigitte Cantinieaux, Hematology Department, LHUB-ULB, Brussels, Belgium, E-mails: phuong.nguyenvothanh@lhub-ulb.be and brigitte.cantinieaux@lhub-ulb.be.

These authors contributed equally to this work.

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