SUBACUTE MALARIA DUE TO PLASMODIUM-FALCIP ARUM IN 43 SUBJECTS RETURNING FROM CHLOROQUINE-RESISTANCE AREAS IN AFRICA

Purpose. - To identify clinical and biological features of subacute fa lciparum malaria, risk factors, and to evaluate the efficacy of curati ve treatment. Patients and methods. - Diagnostic criteria were the ass ociation of apyrexia, anemia, little or no parasitemia and a high tite r of anti-Plasmodium antibodies. Forty-three cases were observed in su bjects returning from chloroquine-resistant areas in Africa. They were matched with controls for age, country of residence and duration of s tay. Controls were missionaries who attended our unit for a routine me dical check-up during the study period. Results. - The clinical presen tation and biological features were similar to << malarial cachexia >> , a condition mainly described in non-immune children in endemic areas . Splenomegaly was present in 58% of the patients. Biological features included little or no parasitemia, an overall decrease in the blood c ell count, an increased erythrocyte sedimentation rate and a high tite r of anti-Plasmodium antibodies. This syndrome was not correlated with the frequency of chloroquine resistance, the area of stay (urban or r ural) or to the kind of chemoprophylaxis. Conclusions. - This study de scribes subacute resistant falciparum malaria in patients who had prol onged stay in chloroquine-resistant areas of Africa associating spleno megaly, cytopenia and a low or absent parasitemia. Subacute chloroquin e-resistant malaria could be due to host factors which remained to be determined by prospective immunological studies. Curative treatment wi th mefloquine is effective.