key: cord-0833879-mvwii07m
authors: Schubert, Lorenz; Thurnher, Majda M; Machold, Klaus; Tobudic, Selma; Winkler, Stefan
title: Pandemic-related delay of falciparum malaria diagnosis in a traveler leading to cerebral malaria
date: 2021-10-05
journal: J Travel Med
DOI: 10.1093/jtm/taab159
sha: 8537fa974ba9abaf164e08f464d22b73f44c1b5e
doc_id: 833879
cord_uid: mvwii07m

We report the case of a 29-year-old male in whom COVID-19 concerns led to a delayed diagnosis of falciparum malaria. The patient developed symptoms of cerebral malaria with cytotoxic lesions of the corpus callosum (CLOCC) in magnetic resonance imaging (MRI).

home for another week as he was afraid of the ongoing Coronavirus pandemic. The patient was born in Zanzibar, but stayed in Austria for the last 10 years.

Clinical examination at admission revealed diffuse abdominal pain, scleral icterus as well as a subtle impairment of consciousness. A dark discoloration of the urine was noticeable.

Laboratory analysis demonstrated thrombocytopenia (31 G/L; normal range, 150 -350 G/L), anemia (hemoglobin 9.9 g/dl; normal range, 13.5 -18 g/dl), acute kidney injury (creatinine 

Today, around 5500 cases of malaria are imported to EU countries per year, of which 10% progress to severe malaria. 1 Zanzibar reported 5146 cases of malaria in 2018. 2 Hence, malaria prophylaxis is recommended for travelers to Zanzibar. The reported patient did not seek pretravel advice or took malaria prophylaxis, which is a frequently reported problem in travelers

visiting friend and relatives (VFR). 3 An increase of severe malaria cases associated with a delay of diagnosis and treatment during the COVID-19 pandemic was recently reported from France. 4 The increased time between the onset of symptoms and malaria diagnosis in our patient was clearly attributable to his concerns about COVID-19, resulting in progression to cerebral malaria with development of CLOCC in MRI imaging.

CLOCC are secondary lesions reported in a wide range of cerebral infections. 5 In a series of children with cerebral malaria from Malawi CLOCC was the second most common finding of white matter diffusion restriction in MRI, however, similar lesions were shown to be present also in uncomplicated cases of imported malaria. 6 Thus, whether CLOCC clearly represents cerebral involvement or even precedes clinical deterioration in malaria remains to be elucidated. In all, this case demonstrates that access and provision of pre-travel healthcare for travelers VFR still has to be improved and that awareness of classic tropical diseases remains essential in times of a pandemic. 7 

FY 2020 Tanzania Zanzibar Malaria Operational Plan

Barriers to malaria prevention in USbased travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers

Increased risk of severe malaria in travellers during the COVID-19 pandemic

Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations 1

Brain magnetic resonance imaging in imported malaria

Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence

SW were responsible for patient care, LS and SW wrote the manuscript; MT, was responsible for preparation of MRI images