Introduction: The aim of treatment for falciparum malaria therapy is to achieve adequate clinical and parasitologic response within 7 days of starting treatment, with no subsequent relapse. We report and discuss the atypical course of a falciparum malaria attack observed in an asplenic patient returning from Burkina-Faso.
Case: This 34-year-old man was hospitalized for severe malaria and treated for 7 days with quinine, as an inpatient. Adequate early clinical response was observed. Twenty days after the end of the quinine course, he was readmitted for uncomplicated falciparum malaria. Inpatient treatment used mefloquine this time. Clinical response was adequate, but the blood smear was still positive 10 days later. It was decided not to administer further treatment at that time. Subsequent clinical and parasitologic assessments 1 month and 3 months later showed the patient was cured.
Conclusion: This report illustrates the critical role played by the spleen in parasite clearance. Clinical and parasitologic assessments are essential after treatment of asplenic patients for falciparum malaria.