Two Imported Malaria Cases with Delayed Response to Treatment in Hatay.

Abstract

The study presents two imported malaria cases with a history of travel to malaria-endemic areas and replied late response to treatment. In the blood preparations of the first case, dot-shaped nucleus structures were identified in the erythrocytes, which looked different from the classical erythrocytic forms. In the SD-Pf/Pan test, bands were obtained for both P.f and Pan; while in the SD-Pf/Pv test, a band was obtained for P.f. The P. falciparum 18S rRNA gene was detected using real-time polymerase chain reaction. Artemether-lumefantrine treatment protocol was started. Due to deterioration in general condition on the third day, artemether-lumefantrine treatment was extended to six days, and primaquine phosphate was added. Discharge was on the 16^th day of treatment. In the second case, young trophozoites were identified in blood smears. Bands in P.f were obtained in both the SD-Pf/Pan and SD-Pf/Pv tests. Artemether-lumefantrine treatment protocol was started. On the third day of treatment, banana-like gametocytes were observed in blood smears. The patient was discharged at his own request and two days later, upon follow-up, gametocytes were still observed in blood smears. Artemether-lumefantrine treatment was restarted. Gametocytes continued to be observed in the following days. Primaquine phosphate was added to the treatment protocol. The patient was discharged after a 3-week follow-up. The study is presented to draw attention to the increasing cases of imported malaria in Hatay and the increase of malaria cases that respond late to treatment in recent years.