Malaria Prophylaxis in Patients with Renal Impairment

Delayed Diagnosis of Falciparum Malaria with Acute Kidney Injury

Prompt malaria diagnosis is crucial so antimalarial drugs and supportive care can then be rapidly initiated. A 15-year-old boy who had traveled to Africa (South Africa, Kenya, and Nigeria between January 3 and 25, 2011) presented with fever persisting over 5 days, headache, diarrhea, and dysuria, approximately 17 days after his return from the journey. Urinalysis showed pyuria and hematuria. Blood examination showed hemolytic anemia, thrombocytopenia, disseminated intravascular coagulation, and hyperbilirubinemia. Plasmapheresis and hemodialysis were performed for 19 hospital days. Falciparum malaria was then confirmed by peripheral blood smear, and antimalarial medications were initiated. The patient's condition and laboratory results were quickly normalized. We report a case of severe acute renal failure associated with delayed diagnosis of falciparum malaria, and primary use of supportive treatment rather than antimalarial medicine. The present case suggests that early diagnosis and treatment is important because untreated tropical malaria can be associated with severe acute renal failure and fatality. Physicians must be alert for correct diagnosis and proper management of imported tropical malaria when patients have travel history of endemic areas.

Bites and mites: prevention and protection of vector-borne disease

PURPOSE OF REVIEW

Vector-borne diseases (VBDs) are difficult to prevent and control because it is hard to predict the complex habits of mosquitoes, ticks and fleas; most vector-borne viruses or bacteria infect animals as well as humans, which further adds to this difficulty. Thus, prevention is the best protection against VBD.

RECENT FINDINGS

Vaccines are available for yellow fever, Japanese encephalitis and tick-borne encephalitis and several vaccines are in clinical trials for dengue fever. Antimalarial intermittent preventive therapy (sulfadoxine-pyrimethamine) and insecticide-treated mosquito nets are associated with a decreased risk of neonatal mortality and lower birth-weight. Permethrin-impregnated clothing for the prevention of tick bites has been shown effective in reducing tick bites.

SUMMARY

Much progress has been made in terms of development of preventive vaccines and medicines, but there is more work that needs to be done. Efforts still need to continue on raising awareness for prevention of VBD.