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Table 2 Non-transfusion cases of delayed presentation of falciparum malaria

From: The duration of Plasmodium falciparum infections

Author, country, reference Case description Time interval since last infection or exposure
Nagley et al., UK [43] 49-years-old male, British soldier, in India from 1919 to 1928. History of malaria in India and one unconfirmed “relapse”. Self-treated with quinine in 1932. No other relevant travel, or blood transfusions. Developed jaundice and then severe malaria in 1945. P. falciparum trophozoites and gametocytes on microscopy 13-17 years
Walters et al., UK [44] 21-years-old pregnant female, originally from Nigeria. Asymptomatic. Diagnosis made by microscopy performed to investigate abnormal routine antenatal full blood count in 1958 19 months
Russell et al., USA [45] Medical student with annual episodes of smear positive falciparum malaria for 4 years after return from the Belgian Congo in 1934. Eventually cleared following a prolonged course of quinine 4 years
Revel et al., France [46] 7-years-old male, originally from Comoros islands presenting with a febrile illness. P. falciparum trophozoites and gametocytes seen on microscopy, mixed with P. ovale. 3 years
Kyronseppa et al., Finland [47] 46-years-old male sailor, last travel to endemic area was Jeddah 20 months previously. Other possible occupational exposure in late 1970s. Presented with fever after head injury (intracerebral bleed). P. falciparum diagnosed by microscopy 20 months
Krajden et al., Canada [48] 30-years-old male, originally from Ghana. Presented with diabetic ketoacidosis. Malaria diagnosed by microscopy. Serology positive. 32 months
MMWR USA [49] Obstetrician/gynaecologist admitted with fever. Last trip to a malarious area was 15 years before (Afghanistan). Diagnosed on microscopy. Labelled as cryptic malaria (occupational exposure cannot be excluded). 15 years (unless occupational exposure)
Howden et al., Australia [16] 28-years-old female, born in Eritrea and then lived in Sudan. Post splenectomy malaria. Pre-operative slides negative. Retrospective histological diagnosis of hyperreactive malarial splenomegaly. 9 years
Giobbia et al., Italy [50] 29-years-old pregnant woman. Originally from Ghana but living in Italy for 9 years. Last trip to Ghana 4 years previously. Presented with fever and vomiting. Positive P. falciparum rapid diagnostic test, microscopy and serology. 4 years
Lesko et al., USA [51] Congenital falciparum malaria in the infant of a mother who had not been in Haiti for 7 years 7 years
Greenwood et al., Sweden [52] 18-years-old male with sickle-cell anaemia, born in Togo, living in Sweden for 14 years. Last visit 4 years previously. Presented with fever. Microscopy, RDT and PCR positive for P. falciparum. 4 years
D’Ortenzio et al., France [53] 11 cases summarized as part of a case–control study (variable level of detail):  
26-years-old male, born in France and lived in Madagascar for 2 years where he took regular chloroquine + primaquine prophylaxis. Presented with severe malaria 7 months after return 7 months
5 cases (2 HIV+) with >1 year time lapse since arrival in France >1 year
5 pregnant women >3 years
Theunissen et al., Belgium [54] 30-years-old male, originally from Guinea-Conakry and moved to Belgium 9 years earlier. No other travel of note. Friend from Guinea stayed with him 2 weeks earlier (raises possibility of ‘baggage malaria’). 9 years
Foca et al., Italy [55] 60-years-old Italian engineer, worked in Tanzania for 33 years where he was treated for malaria. Returned to Italy January 2006 and was diagnosed with carcinoma of the lung and splenomegaly. Fever episode 11 months after return to Italy which resolved spontaneously and P. falciparum gametocytes seen on a blood smear 1 month later. 11 months
Szmitko et al., Canada [56] 29-years-old Angolan female. Immigrated to Canada in 1999, no relevant travel in intervening period. History of treated malaria in Angola. Presented with fever. Falciparum malaria diagnosed by microscopy and PCR. 8 years
MMWR USA [41] Case 1: 17-years-old female, USA born, Ghanaian mother, last travel 4 years previously (report implies to Ghana but not stated explicity). Admitted to hospital with falciparum malaria. No details on diagnosis 4 years
Case 2: 31-years-old female, presented to the emergency department with severe falciparum malaria (10% parasitaemia). Travelled to Nicaragua in 2008; took prophylaxis. 2 years
MMWR USA [57] 8-years-old female, originally from Nigeria. Moved to USA 2007, one trip back in 2008. Malaria history not documented. Presented symptomatic to USA hospital. P. falciparum diagnosis confirmed by microscopy and PCR. 3 years
Monge-Maillo et al., Spain [58] 3 cases: No details on clinical presentation or diagnosis. Only age, sex and country of probably acquisition  
Case 1 : 32 -years-old male, Angola 13 months
Case 2 : 17-years-old male, Senegal 14 months
Case 3 : 28-years-old male, Guinea 28 months
Berrevoets et al., Netherlands [59] 48-years-old male, born in Burkina Faso, immigrated to Netherlands 8 years previously, last travel to an endemic country 2.5 years previously. Last anti-malarial drugs in 1997. Admitted with severe malaria confirmed by RDT, microscopy (P. falciparum trophozoites and schizonts) and PCR. 2.5 years
  1. RDT: rapid diagnostic test, PCR: polymerase chain reaction, IFA: indirect fluorescent antibody assay.