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J R Soc Med 2006;99:386
doi:10.1258/jrsm.99.8.386
© 2006 Royal Society of Medicine

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J R Soc Med 2006;99:386
© 2006 The Royal Society of Medicine

Letters

Diagnosing malaria in UK migrants from sub-Saharan Africa

Ayokunle T Abegunde

Directorate of A&E Medicine, William Harvey Hospital, Kennington Road, Ashford, Kent, TN24 0LZ

E-mail: abegs{at}lycos.com

Semi-immune individuals, such as the patient described by Allan and Tahir (April 2006 JRSM1), present a diagnostic challenge in UK emergency departments due to the relatively uncommon presentation of malaria in these settings. The patient probably had recrudescent Plasmodium falciparum infection, caused by persistence of blood forms of P. falciparum in small numbers between attacks. Though exposed to infection in her country, the authors did not state if she had clinical infection prior to leaving, if it was treated, or if she took prophylactic medication before or after arriving in the UK.

Widespread anti-malarial drug resistance in Africa makes the possibility of recrudescent infection more significant.

The Health Protection Agency guidelines would thus provide the greatest sensitivity and specificity for diagnosing malaria.1 Thrombocytopenia which is a relatively common presentation of malaria in Nigerians and other Africans in western countries,2,3 may be a vital clue to the diagnosis in busy emergency departments.

Footnotes

Competing interests ATA is a Nigerian, and a senior house officer in Accident & Emergency medicine on the GPVTS of the Kent, Sussex, and Surrey postgraduate deanery.

REFERENCES

  1. Allan PJ, Tahir HI. How easily malaria can be missed. J R Soc Med 2006;99:201 -2[Free Full Text]

  2. Kehinde MO, Ohwovoriole AE, Ekanem OJ et al. Effect of acute uncomplicated malaria on platelet counts. Niger Postgrad Med J 2005; 12:10 -13[Medline]

  3. Patel U, Gandhi G, Friedman S, Niranjan S. Thrombocytopenia in malaria. J Natl Med Assoc2004; 96:1212 -4[Medline]


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