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Case of Plasmodium vivax malaria contracted in Southern Europe.

A 24-year-old sociologist and his male companion left England on 9 August 1970 on a hitch-hiking holiday, travelling through France and Switzerland and down the Adriatic coast of Italy to Sicily. They then embarked for Sardinia and from there to Corsica, where they spent 12 days on a seaside camping site. On all three islands they slept in the open, some nights without a tent, and sustained multiple insect bites; these were most numerous at St. Florent in Corsica. They left Corsica on 8 September and, travelling by boat and train to London, arrived home on the 9th. Two days later the patient developed malaise, aching pains in the leg muscles, and fatigue. Febrile episodes occurred, lasting up to 18 hours, with intervening afebrile periods of about 24 hours. He was treated initially with antibiotics by his general practitioner without improvement. On day 7 of the illness he had a rigor and his temperature was recorded as 103'F (39-4'C). On day 9 he was admitted to hospital. There was no history of previous illness, and apart from a short holiday in Greece three years previously he had never travelled abroad. He did not admit to any injections apart from the usual immunization procedures. On examination he looked well but his temperature was 101'F (38 3'C). The throat was clear and there were no rashes or skin punctures and no lymphadenopathy apart from a few shotty inguinal nodes. The spleen was soft and enlarged to 8 cm below the costal margin, and the liver was felt 3 cm below the right costal margin. He was not jaundiced. On the evening of the day of admission his temperature rose to 105'F (40 50°C). Investigations.-Haemoglobin 12 3 g/100 ml; white cell count 6,100/mm3 (53% neutrophils, 2% eosinophils, 36% lymphocytes, 9% monocytes); platelet count 36,000/mm3. Blood film examination showed moderate anisocytosis of the red cells, and malaria parasites identified as Plasmodium vivax were seen. There were approximately 20 plasmodia per 10,000 red cells, mainly gametocytes, and also very occasional ring forms. The species was later confirmed by Mr. P. G. Shute, of the Malaria Reference Laboratory. Urine testing showed no haematuria or haemoglobinuria, and a stain of urine deposit for iron granules was negative. Serum bilirubin 10 mg/100 ml, Van den Bergh negative, remaining liver function tests normal. Blood urea 59 mg/100 ml, plasma electrolytes normal.