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Zusammenfassung: Eine zerebrale Beteiligung bei Malaria mit Plasmodium vivax ist ungewöhnlich. Diese schwere Form der Malaria ist üblicherweise durch Plasmodium falciparum bedingt. Wir berichten über eine 18-jährige Patientin aus Pakistan mit langjähriger intermittierender Fieberanamnese, welche 4Monate nach Einreise in die Schweiz erstmals an einer zerebralen Vivax-Malaria erkrankt. Die eindrückliche neurologische Symptomatik mit Amaurosis und Bewusstseinsstörung bildete sich in diesem Fall unter Therapie in wenigen Tagen zurück. Jedoch sind Todesfälle bei zerebraler Malaria durch Plasmodium vivax beschrieben

Cerebral malaria with Plasmodium vivax is uncommon. Normally Plasmodium falciparum is the cause of cerebral malaria. We report about a 18 year old patient from Pakistan with a history of intermittent fever for several months. The patient recovered within a few days; however prognosis can be severe when cerebral malaria is complicating the course of Plasmodium vivax infection.

Malaria is not a disease of the past. As long as worldwide eradication has not been achieved there is a close connection between countries which export it and those which import it. If the European doctor is presently confronted with a feverish disease which may have been brought in from a tropical area, he should immediately think of malaria and take the necessary measures for treatment. If patients or travelers come into the office and enquire about drugs and preventive measures against malaria, the doctor must choose the correct methods. This is best done by two questions: Where have you come from? and Where are you going? In this way the doctor can obtain ideas on the possibility of resistant strains of parasite in the region in question. Tourists should not forget that a rational and regular chemoprophylaxis is the best protection against serious attacks of malaria.

Since 1974 an epidemic of tertian malaria has been spreading around the Adana and Tarsus townships in southern Turkey, with a peak incidence of 115 500 cases in 1977. A further increase is to be expected because the insect vectors have become resistant to insecticides. Since 1975 eleven children and three adults have been treated for P. vivax malaria. They had all stayed in the epidemic area during the transmission season which lasts from July to October. Because of a long primary latent period seven patients only developed first manifestations of the disease six to nine months after leaving Turkey. The classical malarial paroxysms were missing during the first weeks of the primary attack. Several children had a febrile illness over weeks with headache, vomiting, abdominal pain, hepatosplenomegaly, high blood-sedimentation rate and severe haemolytic anaemia, so that appendicitis or septicaemia had been suspected. Tetracyclines and trimethroprimsulphamethoxazole were able to suppress the disease without preventing relapses.

2225 blood samples from Portugal (classed according to historical provinces), 301 blood samples from Guinea-Bissau (classed in tribes) and 697 blood samples from Brazil (classed according to colour of skin) have been tested in the Duffy system. The Portuguese seem to be a sufficiently uniform and autonomous population. This is also true for the (non-rejected) blood-samples from Guinea-Bissau. The Brazilians differ in accordance with their colour of skin. The expected relations between Portugal and its former colonies can be proved. The Duffy system is suited for the distinction of black and non-black populations and enables to recognize extraneous admixtures.

Chloroquine and amodiaquine are demonstrably still the most reliable drugs for the treatment of malaria, except in the south east Asia area, and in parts of south and central America where an altered sensitivity of falciparum plasmodia has been confirmed. The present position of malaria prophylaxis is, unfortunately, anything but satisfactory. But there are already some good preparations which, if correctly used with consideration of all available information, contribute considerably to the prevention of an infection.

Several basic principles of the diagnostics and therapy of malaria were repeated from own experience. On the basis of two casuistics the difficulties are shown which may be develop in positive proof of plasmodia, when the acute clinical picture is not caused by the malarial parasites, but represents an independent secondary disease.

Between 1980 and 1985 falciparum malaria was diagnosed in 28 and tertian malaria in 17 patients. Only three of the 35 non-immune patients complied with the appropriate chemoprophylaxis; these three patients nevertheless developed tertian malaria (recurrences caused by "dormant" merozoites). The main drawbacks of chemoprophylaxis were lack of patient compliance (26 out of 35 patients) and inappropriate medical advice (14 out of 35 patients). Initial symptoms developed within one month after the end of exposition in 21 out of 23 patients infected by Plasmodium falciparum, but only in three out of twelve cases of tertian malaria. Risk of infection by Plasmodium falciparum is highest in Africa, while most of the malaria cases in India are caused by Plasmodium vivax. Long-term prophylaxis using pyrimethamine-sulfadoxine (Fansidar) is not advisable as there is a risk of life-threatening side effects.

Out of 880 sera which were examined for antibodies to plasmodia 69 (7.8%) reacted only with P. falciparum antigen, 371(42.2%) reacted only with P. fieldi antigen, and 440 (50%) responded to both antigens. These groups were differentiated further with antigens from P. vivax, P. ovale, and P. malariae. The results showed that the P. ovale antigen was distinguished by a marked activity with those sera that had reacted only with P. fieldi in the screening test. With sera that had responded to both antigens or only to P. falciparum antigen in the screening test there was no such clear differentiation of the antibodies. P. falciparum was a less sensitive antigen for the demonstration of plasmodial antibodies (590, i.e. 57.8%, of the sera were positive) than P. fieldi (811, i.e. 91.2% of the sera were positive). The explanations given in the literature for the group and species specific reactions are discussed.

A case of connatal malaria due to Plasmodium vivax in a newborn of turkish origin is presented. Most likely the infection was acquired by materno - fetal transfusion during labor. Pathophysiological aspects and mode of transmission of this rare disease are discussed.

In infections with P. falciparum and P. vivax antibody titers were found to differ in relation to strains. Various strains of both Plasmodium species used as antigens showed differences in their sensitivity in reactions with one patient serum. In P. vivax infections it is supposed that some antibody titer differences are caused by antigen variations.

A drug addict, treated because of a lung abscess, was found to have plasmodium vivax malaria and was treated accordingly. The second patient acquired falciparum malaria inspite of chloroquine prophylaxis and was admitted with a thrombocytopenia of 24 000 mm3. After chloroquine treatment the platelet count became normal. Thrombocytopenia is usually present in falciparum malaria. Complications and their treatment are discussed.

In the past 10-15 years there has been a continuous increase of imported cases of malaria in the Federal Republic of Germany. The case of a two-year-old child of a Turkish foreign worker with severe tertian malaria complicated by pulmonary edema is described. In general tertian malaria is rarely fatal to adults, but in children the primary attack can be life threatening.

Homologous and heterologous malaria pathogens were used as antigens for the determination of malaria antibodies by indirect immunofluorescence. Homologous antibodies fell in the second half year, after successful treatment, down to the limit of demonstrability. In inhabitants of endemic malarial areas, who lived in the German Federal Republic, signs of a fall in antibodies could be observed after about 30 months. The predominance of particular malaria pathogens of the country of origin was recognizable in the antibody spectrum of these persons. Malaria antibody findings of three comparable groups of exposed persons under chemoprophylaxis ought to provide pointers to the parasitemias which had occurred and which were held responsible for the antibody production. Persons without chemoprophylaxis from malarial areas served as controls. The markedly deviating results of the antibody findings in the serum donors can only be explained by more seldom parasitemias in persons with adequate chemoprophylaxis.

This is a report about a 9 year old turkish boy suffering from recurrent episodes of high fever caused by Plasmodium vivax-infection (Malaria tertiana), 12 months after returning from his malarious homeland. After a 3-day course of Chloroquin, we administrated Primaquin to eliminate residual extraerythrocyte forms of Plasmodium vivax. On the 7th day of treatment acute haemolysis developped. This was caused by Glucose-6-Phosphate-Dehydrogenase-Deficiency, which could be demonstrated by a red-cell-enzyme analysis. The investigation of the patient's whole family showed the typical recessive X-linked inheritance of this enzyme-defect. Frequency and clinical manifestations of this defect are discussed.

It is reported on three cases of malaria tertiana and on one case of malaria quartana in combination with a peritoneal tuberculosis, emphasizing the differential-diagnostic problems.