Title : ecurrent Plasmodium falciparum infection in a pediatric traveler following artemisinin-based combination therapy
Abstract:
Transmitted primarily through the bite of a female Anopheles mosquito, malaria is a potentially fatal disease that is endemic throughout most of the tropics. Cases in the United States are rare and are usually the result of international travel to areas such as sub-Saharan Africa and parts of South America and Southeast Asia. Despite control strategies such as vector management and chemoprophylaxis, malaria remains a global health challenge with relapse being a major contributor to the burden and transmission of the disease. Plasmodium Vivax and Plasmodium Ovale are the most common culprits of this, but even more unusual, is the recurrence of Plasmodium Falciparum malaria despite artemisinin combination therapy (ACT).
We report a seventeen-year-old male who presents with recurrent malaria after being treated with ACT in Akwa Ibom, Nigeria. The patient clinically improved after initial treatment, however, a month after, he presented with recurrent symptoms such as fever, malaise, abdominal pain and diarrhea. Blood smear revealed 3% parasitemia and subsequent testing by the state lab confirmed Plasmodium Falciparum. P falciparum is highly endemic to Sub-Saharan Africa and accounted for 97% of cases worldwide in 2023. Despite rare reports of recurrence in this strain, a high level of suspicion is crucial in patients with travel to this endemic region.
Recurrence within 4-6 weeks after ACT raises concern for recrudescence and emerging resistance, though reinfection remains possible in travelers with prolonged exposure. In this case, reinfection was favored, supporting reuse of the same ACT. However, concerns about resistance underscore the importance of case-by-case evaluation, regimen selection and collaboration with public health authorities.
