PDF(Pubmed)
Abstract：
This case report presents a perplexing case of Plasmodium malariae breakthrough infection despite prophylaxis with appropriate antimalarial prophylactic regimen of mefloquine in a compliant patient. A 78-year-old missionary who travels each year to the African subcontinent for multiple weeks to months, over 25 years, adheres to stringent antimalarial prophylaxis with Mefloquine as prescribed, starting prior to the trip and continuing after the return to the U.S.A. She gave no prior history of malaria during her 25 years of travel to Africa and back. Since she had no prior history of malaria and due to her excellent compliance with antimalarial regiment, despite her presentation which were suggestive of malaria, neither the patient nor her providers recognized the onset of malaria in this case. Infectious diseases physicians approached this case with an open mind, investigated appropriately, requested appropriate tests, found the presence of malarial parasite, identified as P. malariae species thereafter. She was started on antimalarial treatment in a timely fashion and showed an excellent response. This intriguing recovery of malarial parasite and response to treatment despite the patient being on antimalarial prophylaxis raised the possibility of mefloquine failure as an antimalarial prophylactic agent against P. malariae species.
摘要：
该病例报告提出了一个令人困惑的疟疾疟原虫突破感染病例，尽管在依从性患者中采用了适当的甲氟喹抗疟预防方案进行了预防。一位78岁的传教士，每年到非洲次大陆旅行数周至数月，超过25年,坚持严格的抗疟疾预防与甲氟喹规定，旅行前开始，返回美国后继续在她往返非洲的25年中，她没有提供疟疾的历史。由于她没有疟疾病史，并且由于她对抗疟药团的良好依从性，尽管她的演讲暗示了疟疾，在这种情况下，患者和她的提供者都没有意识到疟疾的发作。传染病医生以开放的心态对待这个病例，适当调查，要求适当的测试，发现了疟疾寄生虫的存在,此后被鉴定为疟原虫。她及时开始接受抗疟药治疗，并表现出良好的反应。尽管患者正在进行抗疟预防，但这种疟疾寄生虫的恢复和对治疗的反应却引起了甲氟喹作为针对疟原虫的抗疟预防剂失败的可能性。
