Authors:

Abstract

Malaria was rampant in Sri Lanka two decades ago but we have since been declared free of malaria transmission by the WHO in 2016. However, neighboring India still has a high incidence of malaria, and visitors to India carry a high risk of contracting this disease.  Despite the elimination of indigenous cases of malaria in Sri Lanka, a fair number of cases are detected from travelers coming from endemic regions of the globe.  Delay in diagnosis occurs due to a lack of awareness among the medical community and a missed travel history as observed in this case scenario.

We report a 71-year-old previously healthy Sri Lankan male who developed a febrile illness after sixteen days of traveling in India on pilgrimage. He presented with a six day history of of illness and it took a further seven days to consider malaria as a possible diagnosis. Malaria antigen was positive on day thirteen of the illness with Plasmodium vivax trophozoites and gametocytes seen on the thick and thin films. He was treated with chloroquine and recovered slowly with clearing of parasitaemia. A correct diagnosis and close liaison with the anti-malaria campaign helped in the successful management of our patient.

This report is an eye opener to consider malaria as a diagnostic possibility and a clinical dilemma and to take a detailed travel history in patients presenting fever. Raising awareness of travelers about prevention against malaria and the need for malaria prophylaxis is also necessary.

Keywords: Malaria, Plasmodium vivax, Travel