Correspondence

Malaria Imported from Somalia

N Engl J Med 1993; 328:1046-1047April 8, 1993

Article

To the Editor:

Malaria should be considered in the differential diagnosis of fever in any patient returning from an area where the disease is endemic1. During the Vietnam War, there were more than 14,000 cases of imported malaria among U.S. military personnel2. We are concerned that U.S. troops who served in Somalia in Operation Restore Hope may present with imported malaria after returning home3.

A 21-year-old Marine was deployed to Mogadishu, Somalia, on December 15, 1992. The patient received a third-degree burn on December 24. Subsequently, he was evacuated to a U.S. military medical facility in Germany. On January 10, fever secondary to wound infection developed. Intravenous antibiotic therapy was initiated, with prompt defervescence.

The patient arrived at Naval Hospital on January 25. He underwent split-thickness skin grafting the next day. The patient was afebrile until January 31, when fever as high as 40 °C developed. A peripheral-blood smear revealed Plasmodium vivax. The patient reported poor use of mosquito netting and said he had missed two doses of doxycycline chemoprophylaxis while in Somalia. Terminal chemoprophylaxis did not include primaquine, and doxycycline had been discontinued after only three days since the patient was now “out of country.”

This patient's is the first case of imported malaria from Operation Restore Hope seen at our institution. An additional case of P. falciparum malaria imported from Somalia has been diagnosed at the Naval Hospital at Camp Pendleton, California (Schindler W: personal communication).

Military personnel frequently go home on leave after long deployments. They may present with a fever to any physician or community hospital across the United States. Experience suggests that they may not have completed their malaria prophylaxis. During the Vietnam era, 70 percent of U.S. military personnel were noncompliant with terminal chemoprophylaxis2. Imported malaria should be considered in the differential diagnosis of fever in any patient seen within 12 months after returning from Somalia.

(The views expressed in this letter are those of the authors and do not reflect the official policy or position of the Department of the Navy, the Department of Defense, or the U.S. government).

William D. Bone, M.D., Lt. Comdr., M.D., Lt. Comdr., M.C., U.S.N.
James A. Newton,, M.D., Lt. Comdr., Jr., M.D., Lt. Comdr., M.C., U.S.N.
Edward C. Oldfield, III, M.D., Capt., M.C., U.S.N.
Naval Hospital, San Diego, CA 92134

3 References

1. 1

   Kean BH, Reilly PC Jr. Malaria -- the mime: recent lessons from a group of civilian travellers. Am J Med 1976;61:159-164
   CrossRef | Web of Science | Medline

2. 2

   Barrett O Jr, Skrzypek G, Datel W, Goldstein JD. Malaria imported to the United States from Vietnam: chemoprophylaxis evaluated in returning soldiers. Am J Trop Med Hyg 1969;18:495-499
   Web of Science | Medline

3. 3

   Oldfield EC, Rodier GR, Gray GC. The endemic infectious diseases of Somalia. Clin Infect Dis (in press).