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Published Date: 2018-05-14 10:57:06

Subject: PRO/AH> Malaria - USA: ex Costa Rica: (PU)

Archive Number: 20180514.5790914
MALARIA - USA: ex COSTA RICA (PUNTARENAS)

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International Society for Infectious Diseases

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Date: Wed 9 May 2018

From: Henry Wu [edited]





Henry Wu from the GeoSentinel Atlanta site recently reported a case of _Plasmodium falciparum_ malaria in an American tourist returning from Costa Rica.



The traveler was a tourist from the United States, without significant recent travel history. He visited a less traveled area in eastern Costa Rica, near Panama.



The patient's Costa Rica itinerary (7-20 Apr 2018) was as follows: Drake Bay, La Tarde, and El Remanso. The patient did not use repellents. Illness onset was the night 28 Apr 2018 with fever on 29 Apr 2018. Prior travel reported: St Thomas, Virgin Islands June 2017, and a trip to Tanzania in 2015 (for which he took Malarone prophylaxis).



This patient had a positive RDT [rapid diagnostic test] for _P. falciparum_ but surprisingly, 2 thick smears, one before and another 24 hours after treatment was started, were both negative. Initially the case was considered to be a false positive RDT (T1 band), but PCR done at the US CDC was positive. He recovered after treatment with Malarone. CDC is considering it a confirmed case for their surveillance at this point.



The case is unusual because this area is not considered a malaria risk area and only mosquito bite avoidance is recommended. Furthermore, it underscores how unpredictable malaria epidemiology can be, particularly in areas of migration movement. From the travel and illness onset dates, it does appear most likely that this American tourist contracted falciparum malaria in an area of Costa Rica that is not considered a risk area for malaria. When it comes to travelers' malaria, always expect the unexpected.



--

Henry Wu, MD

GeoSentinel Site Director

Atlanta

Patricia Schlagenhauf, PhD

Chair, Tracking and Communication Working Group

GeoSentinel

David Hamer, MD

GeoSentinel PI



[As underlined in the comment above, Costa Rica is considered to be free of malaria. We assume that the patient was infected my mosquitoes and therefore there must be other cases close to his itinerary. Alternatively, he was infected by migrants in Costa Rica from malaria endemic areas. All of these locations are on the Osa Peninsula, Puntarenas Province.



In 2004, PAHO reported 1289 cases of all species of malaria in Costa Rica of which 5 were mixed _P. falciparum_ malaria cases; all the remaining were _P. vivax_. In 2006, Costa Rica reported an outbreak of 13 cases of falciparum malaria in the Caribbean province of Limon.



ProMED will be interested in posting further information. - Mod.EP



HealthMap/ProMED-mail map

Península de Osa, Puntarenas, Costa Rica: http://healthmap.org/promed/p/39539]

See Also

2017

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Costa Rica: increased risk alert : 20170918.5323282

2006

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Malaria - Costa Rica (Limon): 20061116.3280

.................................................ep/mj/lxl

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