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Ovale malaria: a case report from Kuwait
670 Quinn, T. C. & Strickland, G. T. (1986). Clinical manifestations of malaria. Clinical Tropical Medicine and Cmnrnunicable Diseases, 1, 127-170. Strickland, G. T., Zafar-Latif, A., Fox, E., Khaliq, A. A. & Chowdhury, M. A. (1987). Endemic malaria in four
villages of the Pakistani province of Punjab. Transactions of the Royal Sociery of Tropical Medicine and Hygkne, 81, 36-41.
Received 8 Februay 1988; revised 7 April accepted for publication 20 April 1988
1988;
TRANSACTIONS OF THE ROYALSOCIETY OF TROPICAL. MEDICINEAND HYGIENE(1988)82, 670
1 Short Report 1 Ovale malaria: Kuwait
a case report from
Ali Sher” Yacoub K. Al-Motawwa’
and Rashed A. Al-Owaisl? ‘Malaria Laboratory, ‘Public Health Laboratories, 3Department of Public Health, Ports & Borders Health Division, Ministry of Public Health, P.O. Box 5 Safat, 13001 Safat, Kuwait A 27 year old man from Kuwait visited Muwasat Hospital on 17 February 1986 with the principal complaints of headacheand intermittent fever over a period of 10 d. He gave a history of going to Saudi Arabia (Makkah and Medina) by car on 17 January 1986 and returning on 26 January 1986. He gave no history of visiting Africa. The typical signs and symptoms of vivax malaria and ovale malaria were noted. After treatment with chloroquine the patient recovered and was discharged on 2 February 1986. His blood film was sent to this laboratory on 2 March 1986for confirmation of the diagnosis. The thin blood fih~~was f&d in methanol and stained with Giemsa (pH 7.2). About 20% of the erythrocytes infected
infected erythrocytes. These characters confirmed that the specieswas Plasmodium ovale (MATSUMOTO et al., 1986b). The growing trophozoites were compact, not amoeboid, differing from the corresponding stageof P. vivax and suggesting less active movement (MATSUMOTO et al., 1986a). Schizonts had 8 merozoites, arranged in a rosette form. This further confirmed the infection as being due to P. ovale and not P. vivax. The figure shows different stagesof P. ovale from this patietit, with their characteristic features. Comment P. ovale infection is generally believed to be
confined to Africa. As Makkah and Medina are religious placesin Saudi Arabia, people come from all over the world to perform their religious rituals every year. Transmission of malaria is prevalent in Saudi Arabia. Apparently, therefore, the vector in this case became infected from a carrier of P. ovale infection from Africa while resident in Saudi Arabia. P. ovate is often misdiagnosed as P. vivax, since proper differentiation needs long experience and expertise. Most microscopists, at times, find it difficult to differentiate between the two, particularly when the diagnosis is influenced by the assumption that ovale malaria is confined to Africa. We think that this caseis worth reporting as it was found outside Africa in a non-African patient. Microscopists working in malaria laboratories in Middle East countries, especially in Saudi Arabia, should pay more attention to the morphological detals of malaria parasites. Acknowledgement We thank Dr H. M. Gilles, Dean and Professor of Tropical Medicine, Liverpool School of Tropical Medicine, for confirmation of the species diagnosis.
Figure. Parasiteson thin Giemsa-stained bloodfilm. (a) Ring stage, (b), trophozoiteand (c) gametocyte.The infectederythrocytesare oval and enlarged, with numerousSchiiffner’sdots.
with parasites were oval in shape and some had fimbria, either on one or both sides, and there were many large clumps of Schiiffner’s dors on most ‘Address for correspondence: Dr Ali Sher, Ministry of Public Health, Ports & Borders Health Division, Malaria Laboratory, P.O. Box 5 Safat, 13001 Safat, Kuwait.
References Matsumoro, Y., Matsuda, S. & Yoshida, Y. (1986a). Ultrastructure of erythrocytic stages of Plasmodium ovale in humans. American Journal of Tropical Medicine and Hygiene, 35, 689-696. Matsumoto, Y., Matsuda, S. & Yoshida, Y. (1986b). Ultrastructure of human erythrocytes infected with Plasmodium wale. AmericanJournal of Tropical Medicine and Hygiene, 35, 697-703.
Received 29 February 1988; accepted for publication 8 March 1988
Announcement East Medicare II will be held on 23-26 October 1989 in Manama, Bahrain. Further information can be obtained from: Mr Mohammed Sultan, Sahnaniya Medical Centre, P.O. Box 12, State of Bahrain.
Middle
villages of the Pakistani province of Punjab. Transactions of the Royal Sociery of Tropical Medicine and Hygkne, 81, 36-41.
Received 8 Februay 1988; revised 7 April accepted for publication 20 April 1988
1988;
TRANSACTIONS OF THE ROYALSOCIETY OF TROPICAL. MEDICINEAND HYGIENE(1988)82, 670
1 Short Report 1 Ovale malaria: Kuwait
a case report from
Ali Sher” Yacoub K. Al-Motawwa’
and Rashed A. Al-Owaisl? ‘Malaria Laboratory, ‘Public Health Laboratories, 3Department of Public Health, Ports & Borders Health Division, Ministry of Public Health, P.O. Box 5 Safat, 13001 Safat, Kuwait A 27 year old man from Kuwait visited Muwasat Hospital on 17 February 1986 with the principal complaints of headacheand intermittent fever over a period of 10 d. He gave a history of going to Saudi Arabia (Makkah and Medina) by car on 17 January 1986 and returning on 26 January 1986. He gave no history of visiting Africa. The typical signs and symptoms of vivax malaria and ovale malaria were noted. After treatment with chloroquine the patient recovered and was discharged on 2 February 1986. His blood film was sent to this laboratory on 2 March 1986for confirmation of the diagnosis. The thin blood fih~~was f&d in methanol and stained with Giemsa (pH 7.2). About 20% of the erythrocytes infected
infected erythrocytes. These characters confirmed that the specieswas Plasmodium ovale (MATSUMOTO et al., 1986b). The growing trophozoites were compact, not amoeboid, differing from the corresponding stageof P. vivax and suggesting less active movement (MATSUMOTO et al., 1986a). Schizonts had 8 merozoites, arranged in a rosette form. This further confirmed the infection as being due to P. ovale and not P. vivax. The figure shows different stagesof P. ovale from this patietit, with their characteristic features. Comment P. ovale infection is generally believed to be
confined to Africa. As Makkah and Medina are religious placesin Saudi Arabia, people come from all over the world to perform their religious rituals every year. Transmission of malaria is prevalent in Saudi Arabia. Apparently, therefore, the vector in this case became infected from a carrier of P. ovale infection from Africa while resident in Saudi Arabia. P. ovate is often misdiagnosed as P. vivax, since proper differentiation needs long experience and expertise. Most microscopists, at times, find it difficult to differentiate between the two, particularly when the diagnosis is influenced by the assumption that ovale malaria is confined to Africa. We think that this caseis worth reporting as it was found outside Africa in a non-African patient. Microscopists working in malaria laboratories in Middle East countries, especially in Saudi Arabia, should pay more attention to the morphological detals of malaria parasites. Acknowledgement We thank Dr H. M. Gilles, Dean and Professor of Tropical Medicine, Liverpool School of Tropical Medicine, for confirmation of the species diagnosis.
Figure. Parasiteson thin Giemsa-stained bloodfilm. (a) Ring stage, (b), trophozoiteand (c) gametocyte.The infectederythrocytesare oval and enlarged, with numerousSchiiffner’sdots.
with parasites were oval in shape and some had fimbria, either on one or both sides, and there were many large clumps of Schiiffner’s dors on most ‘Address for correspondence: Dr Ali Sher, Ministry of Public Health, Ports & Borders Health Division, Malaria Laboratory, P.O. Box 5 Safat, 13001 Safat, Kuwait.
References Matsumoro, Y., Matsuda, S. & Yoshida, Y. (1986a). Ultrastructure of erythrocytic stages of Plasmodium ovale in humans. American Journal of Tropical Medicine and Hygiene, 35, 689-696. Matsumoto, Y., Matsuda, S. & Yoshida, Y. (1986b). Ultrastructure of human erythrocytes infected with Plasmodium wale. AmericanJournal of Tropical Medicine and Hygiene, 35, 697-703.
Received 29 February 1988; accepted for publication 8 March 1988
Announcement East Medicare II will be held on 23-26 October 1989 in Manama, Bahrain. Further information can be obtained from: Mr Mohammed Sultan, Sahnaniya Medical Centre, P.O. Box 12, State of Bahrain.
Middle