Malaria Recurrence Caused by Plasmodium falciparum

Shakoora Omonuwa, MD, Smith Omonuwa, MD, MSc


J Am Board Fam Med. 2002;15(2) 

In This Article


Malaria is a parasitic infection transmitted by mosquitoes. Signs and symptoms are high fever with chills, sweating, headache, nausea and vomiting, muscle pain, and bloody stools.[4] If untreated, the infection will recur throughout the person's lifetime. This disease is endemic in parts of Africa, South and Central America, Mexico, Middle East, Southern Asia, and India.[5]

Typically the incubation period of P falciparum can range from 10 to 14 days. The malarial paroxysm begins with less-prominent symptoms, ie, the cold stage. During this stage vasoconstriction lasts from 30 minutes to 1 hour during which the patient feels very uncomfortable. The next stage, the hot stage, lasts 2 to 6 hours during which the patient feels very hot. The cycle ends with the sweating stage.

Infection with P falciparum, which is the only parasite species that is able to invade all red blood cells, especially the young cells, can potentially result in the most severe form of malaria, causing extensive organ damage in kidneys, liver, brain, and gastrointestinal tract. Cerebral malaria in particular can lead to coma and convulsions. Almost all deaths associated with malaria are due to falciparum malaria.

P vivax and P ovale are well recognized as causes of recurrent malaria. Waksman et al[6] reported an 8-month time lag between the traveler's visit to an endemic country and the manifestation of malaria caused by P vivax. Another case report by Grobusch et al[7] described a 22-month delay in the signs and symptoms of P vivax infection. The authors conclude that malaria should be considered even years after traveling. Malaria in the past has been a serious health problem in parts of Europe, United States, and other industrialized countries. Currently, it is recognized as an imported disease in immigrants, military personnel, and travelers.[8]

Several articles have been written on the recurrence of falciparum malaria.[9,10] Malaria recurrence separated by more than 12 months is less likely to be due to P falciparum infection.[11]P falciparum malaria recurrence can occur by two different mechanisms: reinfection and recrudescence. Recrudescence with a long latency is the more likely explanation for this case, because reinfection usually occurs after day 14 of treatment[12] and in endemic areas. Recrudescence can be due to (1) incomplete or inadequate treatment as a result of drug resistance or improper choice of medication, (2) an antigenic variation,[13] and (3) multiple infection by different strains.


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