Malaria Acquired 13 Times in Two Years in Germany

Abstract

The case is reported of a 45-year-old German hospital laboratory worker who took a holiday in Tanzania in March 1994 under malaria prophylaxis with chloroquine and proguanil (chloroguanide). In October 1994, she presented with fever and headache, and a thick blood smear revealed Plasmodium falciparum. She was treated with halofantrine, which led to the relief of symptoms and clearance of the parasites. In January 1995, P. falciparum malaria developed again, and the patient was treated with mefloquine. Between this time and December 1996, 11 further attacks occurred, which were treated with different combinations of quinine, doxycycline, artesunate, sulfadoxine, pyrimethamine, clindamycin, chloroquine, proguanil, and atovaquone. P. falciparum parasites from attacks number 9-13 were investigated for in vitro sensitivity to chloroquine, quinine, and mefloquine, and for the genotypic pattern of their merozoite surface antigen 1 (MSA-1). Parasites from attacks 10 and 12 showed a high susceptibility to quinine and mefloquine, both of which had been administered in earlier attacks. Furthermore, the different lengths of PCR fragments from the MSA-1 gene clearly showed different parasite genotypes in attacks 9-13. In light of this, the patient was interrogated, and she confessed to injecting herself with P. falciparum-infected blood from other patients. The patient received psychiatric treatment.