Malaria was rampant in Sri Lanka two decades ago but we have since been declared free of malaria transmission by the WHO in 2016.However, neighboring India still has a high incidence of malaria, and visitors to India carry a high risk of contracting this disease.Despite the elimination of indigenous cases of Olive Leaf malaria in Sri Lanka, a fair number of cases are detected from travelers coming from endemic regions of the globe.
Delay in diagnosis occurs due to a lack of awareness among the medical community and a missed travel history as observed in this case scenario.We report a 71-year-old previously healthy Sri Lankan male who developed a febrile illness after sixteen days of traveling in India on pilgrimage.He presented with a six day history of of illness and it took a further seven days to consider malaria as a possible diagnosis.
Malaria antigen was positive on day thirteen of the illness with Plasmodium vivax trophozoites and gametocytes seen on the thick and thin films.He was treated with chloroquine steel-cockrings and recovered slowly with clearing of parasitaemia.A correct diagnosis and close liaison with the anti-malaria campaign helped in the successful management of our patient.
This report is an eye opener to consider malaria as a diagnostic possibility and a clinical dilemma and to take a detailed travel history in patients presenting fever.Raising awareness of travelers about prevention against malaria and the need for malaria prophylaxis is also necessary.