Autochthonous Plasmodium vivax malaria in a Greek schoolgirl of the Attica region

In non-endemic countries, malaria cases are mostly imported (from travelers or immigrants), but blood transfusion malaria, or malaria in transplant recipients, or even cases of "airport malaria" can occasionally be seen [1]. Greece has been malaria free since 1974. However, rare cases of autochthonous malaria are occasionally reported. Recently, in August 2011, an announcement was posted by European Centres for Disease Prevention and Control (ECDC) and American Centers for Disease Control and Prevention (CDC) that six autochthonous malaria cases were reported in southern Greece [2,3]. An autochthonous case in a schoolgirl in the Attica region in 2009 is hereby described.A 17-year-old young woman of Greek origin, living in the Eastern Attica region, was admitted to hospital (mid-August, 2009), because of high fever (up to 40.3°C) of abrupt onset with chills for eight days. She also reported sore throat, headache, remarkable weakness and sweating with unpleasant smell. Fever was almost periodic, being higher every second day. Anti-pyretic drugs were causing lysis with excess sweating. Her past medical history was unremarkable. She denied travelling abroad and had no history of blood transfusion. Upon admission, patient was in good condition, and physical examination revealed mild hepatosplenomegaly. There were multiple skin lesions suggesting insect bites, especially on lower limbs. During the first 48 hours of hospitalization, she had fever up to 40°C, symptomatically treated with paracetamol. Initial blood evaluation showed normocytic, normochromous anaemia (haematocrit 31.3%, MCV = 89.6 fL, MCHC = 32.3), thrombocytopaenia (platelets 48,000/μL), with a normal leukocyte count. Liver function tests yielded slightly abnormal results: AST 28 u/L, ALT 71 u/L (reference range < 40), LDH 943 u/L (reference range 230-450), and total bilirubin 1.2 mg/dL (reference range < 1,0). Kidney function tests and coagulation study were normal. ESR was 58 mm, and CRP 139 mg/L (referenc