gms | German Medical Science

12th Malaria Meeting

Malaria Group / Section Antiparasitic Chemotherapy of the Paul-Ehrlich-Society (PEG e. V.) in cooperation with the German Society for Tropical Medicine and International Health (DTG e. V.) and the German Society for Parasitology (DGP e. V.)

14.11. - 15.11.2014, Bonn

Treatment of Malaria caused by Plasmodium falciparum in Non-Immunes Challenges Communication Skills – An Analysis of Insufficiencies Resulting in Medical Evacuation from East Africa

Meeting Abstract

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  • Burkhard Rieke - Institute for Occupational and Social Medicine, RWTH Aachen, Germany; Center for Tropical and Occupational Medicine, Düsseldorf, Germany

12th Malaria Meeting. Bonn, 14.-15.11.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14mal10

doi: 10.3205/14mal10, urn:nbn:de:0183-14mal101

Published: December 17, 2014

© 2014 Rieke.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



A 19-year old volunteer near Kisumu, Kenya, contracts Plasmodium (Pl.) falciparum malaria of 12% parasitaemia 5 months after arrival. At the time, atovaquone/proguanil chemoprophylaxis had been ended 2 months before due to cost and fear of side effects. Diagnosis is delayed by 4 days and artesunate monotherapy given in the hospital according to local treatment practices. Recrudescence occurs with a parasitaemia of 1.5% and the patient deteriorates with signs of haemolysis and kidney failure. Again, artesunate is given, and the patient transferred to a West German university hospital by medical evacuation. She arrives with no patent parasitaemia, gets no specific therapy and is discharged five days later, as lung and kidney function have improved. Four days later, she gets febrile again, is readmitted with a falciparum malaria recrudescence of 1.5% parasitaemia and treated with a standard course of atovaquone/proguanil.

She presented to us asking whether reexposure to such highly resistant malaria parasites would be advisable. We recommended a continuous doxycycline chemoprophylaxis and prescribed a small package of the drug, as there was an unclear history of previous intolerance. We notified the case to the Statutory Accident Insurance.

The episode addresses a range of questions concerning the preparation and counselling of young adults before embarking on long-term voluntary work in malarious areas and concerning the treatment concepts of the two Kenyan and one German hospitals involved. The overall costs of treating this initially uncomplicated malaria episode will finally have exceeded 120,000 EUR.