POSTMORTEM DIAGNOSIS OF FALCIPARUM-MALARI A

Thirteen days after returning from a four week holiday in Kenya a 35-y ear-old man consulted his doctor complaining of feeling unwell. The do ctor diagnosed influenza and gave him a sickness certificate for three days. Because the patient did not I reappear at his workplace a searc h was made and he was found dead in his nat seven days after seeing hi s doctor. A medicolegal autopsy was performed two days after the estim ated time of death. There was marked swelling of liver and spleen toge ther with jaundice and ''dirty grey'' colouration of the viscera. Samp les of heart blood and spleen puncture material were taken. Giemsa sta ined preparations (ordinary and thick blood smears) revealed numerous objects 1.2 to 1.5 mu m in size with indistinct reddish blue staining, some of them arranged in rosettes reminiscent of schizonts. A few of them contained pigment. In material from the spleen there were masses of blackish-brown pigment. The malaria immunofluorescence test perform ed on serum gave a weakly positive titre of 1 : 40. The findings were considered enough to support a diagnosis of fulminant falciparum malar ia, and this was confirmed by histological changes in various organs, notably the typical capillary blockages ages in the brain. - Because o f the popularity of longhaul tourism, cases of imported malaria are in creasingly frequent and, in view of the insidiously progressive course of the disease, it should always be considered in the differential di agnosis. In cases of unexplained death, if there is any suspicion of m alaria, blood should always be taken for appropriate investigations, i n addition to blocks for histological examination.