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News From the Centers for Disease Control and Prevention
November 6, 2002

Local Transmission of Plasmodium vivax Malaria—Virginia, 2002

JAMA. 2002;288(17):2113-2114. doi:10.1001/jama.288.17.2113

MMWR. 2002;51:931-923

Malaria transmission in the United States was largely eliminated during the mid-20th century; however, sporadic cases of locally acquired mosquito-transmitted malaria continue to occur. Since 1997, four separate probable mosquito-transmitted malaria outbreaks have been reported to CDC, including one from Virginia.1-3 This report describes the investigation of two cases of Plasmodium vivax malaria that occurred in northern Virginia in August 2002, and underscores the need for clinicians to consider the possibility of malaria in patients with fever of unknown origin.

Case 1. On August 23, 2002, a person aged 19 years from northern Virginia sought medical care at a family health clinic with a 4-day history of fatigue, fever, and chills. The patient also complained of muscle aches and sinus pain. A sinus infection was diagnosed, and the patient was prescribed azithromycin and desloratadine. Four days later, the patient returned to the clinic with additional symptoms, dizziness, and nausea. On physical examination, the patient had a temperature of 103.5°F (39.7°C) and tachycardia. Laboratory results revealed pancytopenia (platelet count: 61,000/µL [normal: 130,000-400,000/µL], hemoglobin: 10 g/dL [normal: 11.5-16.0 g/dL], and white blood cell count: 3,300/µL [normal: 4,000-11,000/µL]). The patient's therapy was changed to oral levofloxacin. Malaria parasites were identified subsequently on a routine complete blood count smear taken 4 days after the initial clinic visit. The patient was contacted and administered chloroquine. A review of the initial malaria smear by a local university hospital confirmed the diagnosis of P. vivax malaria. The patient completed a 3-day course of chloroquine therapy and after a normal glucose-6-phosphate dehydrogenase (G6PD) test result was placed on primaquine for 14 days. The patient had complete resolution of symptoms.