Malaria remains a serious public health problem in Shandong Province, China; therefore, it is important to explore the characteristics of the current malaria prevalence situation in the province. In this study, data of malaria cases reported in Shandong during 2012-2014 were analyzed, and Plasmodium species were confirmed by smear microscopy and nested-PCR. A total of 374 malaria cases were reported, 80.8% of which were reported from 6 prefectures. Of all cases, P. falciparum was dominant (81.3%), followed by P. vivax (11.8%); P. ovale and P. malariae together accounted for 6.4% of cases. Notably, for the first time since 2012, no indigenous case had been reported in Shandong Province, a situation that continued through 2014. Total 95.2% of cases were imported from Africa. The ratio of male/female was 92.5:1, and 96.8% of cases occurred in people 20-54 years of age. Farmers or laborers represented 77.5% of cases. No significant trends of monthly pattern were found in the reported cases. All patients were in good condition after treatment, except for 3 who died. These results indicate that imported malaria has increased significantly since 2012 in Shandong Province, especially for P. falciparum, and there is an emergence of species diversity.
Africa ; China* ; Farmers ; Humans ; Malaria* ; Microscopy ; Plasmodium falciparum ; Plasmodium malariae ; Plasmodium ovale ; Plasmodium vivax ; Plasmodium* ; Prevalence ; Public Health

A parasitological study was performed with 452 malaria patients evacuated from South Vietnam by examinations of their peripheral blood. Results were as follows: The peripheral blood examinations revealed that 52.0% of the examined have parasitemia, of which 95.3% was P. falciparum, one case of P. vivax and the other 10 patients were mixed infected. Neither P. malaria nor P. ovale were found. A total of 1,500 thick and thin blood films was prepared and 707 slides of them (47.1%) showed positive. In P. falciparum, ring forms were found most frequently and the next was gametocytes. Eighty slides (50%) showed mixed together with both ring form and gametocytes. All of the erythrocytic stages were seen in three slides of P. vivax. Weekly periodical examinations showed 233.8 parasite density every 1,000 W.B.C count in average, while occasional at fever attacks 531.7.Size of gametocytes in P. falciparum was 9.31(+/-0.89) by 2.16(+/-0.53) in macrogametocyte and 6.61(+/-0.82) by 2.51(+/-0.35) in microgametocyte. Their sex ratio was 100 : 92. Repeated blood examinations showed increased detection rates. The positive rate of parasitemia was 52.0% in single examination, increasing in succession with repetitions.
parasitology-protozoology-malaria ; Plasmodium falciparum ; Plasmodium vivax ; Plasmodium ovale ; Plasmodium malariae ; ring form gametocyte ; epidemiologyk Vietnam ; parasitemia

Primaquine is often administered for the hypnozoite stage of Plasmodium vivax and Plasmodium ovale. Primaquine (with clindamycin) is also an alternative drug for treatment of pneumocystis pneumonia when trimethoprim/sulfamethoxazole cannot be used. Primaquine may cause methemoglobinemia, an altered state of hemoglobin in which the ferrous state of heme is oxidized to the ferric state. We report a case of methemoglobinemia caused by a standard dose of primaquine plus clindamycin in a 27-year-old female recipient of a kidney transplant who was diagnosed with pneumocystis pneumonia.
Adult ; Clindamycin ; Female ; Heme ; Humans ; Kidney ; Methemoglobin ; Methemoglobinemia* ; Plasmodium ovale ; Plasmodium vivax ; Pneumonia, Pneumocystis ; Primaquine*

OBJECTIVE: Annually, the prevalence of indigenous and imported malarial infections is steadily increasing since 1993 in Korea. In order to understand the current characteristics of malarial infections and to prevent, the present research reviewed twenty-seven cases between January and September 1998. METHOD:In this study, all the twenty-seven (twenty- six patients) cases were obtained from admitted patients between January and September 1998. We had performed routine blood chemical studies, peripheral blood thin and thick smear, physical examination and abdominal sonography. Any patient with a previous history of a narcotic drug injection or had blood transfusion was excluded. RESULTS: Twenty cases (74.1%) were indigenous and seven (25.9%) were imported malaria. Yeonchon-Gun (nine cases) was the most prevalent area in the indigenous cases; Cambodia (three cases) were the most one in the imported cases. Peripheral blood thin smear revealed Plasmodium vivax in all (100%) indigenous malaria, while four cases (57.1%) were P. vivax and one (14.3%) was P. falciparum and two (28.6%) were mixed infections with P. vivax and P. falciparum in the imported cases. In a 3-month period between July and September, peak prevalence (80.4%) was observed. The negative conversion of peripheral blood smear was achieved much earlier in the indigenous (3.9+/-1.4day) than in the imported (5.7+/-1.9day) after the treatment but, was not statistically signifcant. CONCLUSION: Plasmodium ovale was the only unique causative species in the indigenous malaria. Also Yeonchon-Gun and Cheolwon-Gun had been the most important endemic areas as previous reports. One relapse case had been occurred in the imported malaria. On the basis of our data, more efforts for control of malaria should be necessary for eradication and prevention of indigenous and imported malarial infections in Korea.
Blood Transfusion ; Cambodia ; Coinfection ; Humans ; Korea ; Malaria ; Physical Examination ; Plasmodium ovale ; Plasmodium vivax ; Prevalence ; Recurrence

Mixed-species malaria infections are often unrecognized or underestimated. We hereby report the first described case of mixed infection with Plasmodium falciparum and Plasmodium ovale malaria in a returned traveller in Korea. In August 2016, a 25-year-old returned traveller from Cameroon and Democratic Republic of Congo presented with fever. He was diagnosed as P. falciparum malaria and successfully treated with artesunate. And 5 weeks after the completion of treatment, he presented with fever and diagnosed as P. ovale infection. P. ovale infection is a rare cause of malaria and often shows delayed presentation due to its dormant liver stage as hypnozoites. At re-presentation, the immunochromatographic test and microscopic examinations of our patient did not reveal P. ovale, which was only detected via polymerase chain reaction (PCR) assay. This case highlights the importance of considering malaria infection even in persons who have previously received malaria treatment. It also shows the usefulness of PCR testing for diagnosing P. ovale infections, which often present with a low level of parasitaemia.
Adult ; Cameroon ; Coinfection* ; Congo ; Fever ; Humans ; Korea* ; Liver ; Malaria ; Plasmodium falciparum* ; Plasmodium ovale* ; Plasmodium* ; Polymerase Chain Reaction

In Korea, the majority of imported malaria cases are Plasmodium vivax and P. falciparum, but Plasmodium ovale cases are rarely reported. We describe an imported case of P. ovale that was confirmed by peripheral blood smear and nested PCR targeting the small subunit ribosomal RNA (SSU rRNA) gene. A 37-yr-old male had visited the Republic of Ghana in tropical West Africa 3 months ago, and suffered from fever and headache since 2 weeks after his return to Korea. The results of rapid malaria test using SD Malaria Antigen/Antibody Kit (Standard Diagnostics, Korea) were negative, but Plasmodium species was observed in Wright-Giemsa-stained peripheral blood smear. For the evaluation of possible mixed infection and identification of species, we performed a nested PCR targeting the SSU rRNA gene. P. ovale single infection was confirmed by PCR. The sequence analysis of the P. ovale SSU rRNA gene showed that our isolate was P. ovale classic type. We should confirm P. ovale infection for an accurate diagnosis and treatment of imported malaria cases in Korea because the number of travelers to P. ovale-endemic regions has recently increased.
Africa, Western ; Coinfection ; Fever ; Genes, rRNA ; Ghana ; Headache ; Humans ; Korea ; Malaria ; Male ; Plasmodium ; Plasmodium ovale ; Plasmodium vivax ; Polymerase Chain Reaction ; RNA, Ribosomal ; Sequence Analysis

There have been reports in Korea of imported malaria cases of four Plasmodium species, but there has been no report of imported Plasmodium ovale malaria confirmed by molecular biological methods. We report an imported case of that was confirmed by Wright-Giemsa-stained peripheral blood smear and nested polymerase chain reaction targeting the small subunit ribosomal RNA gene. The amplified DNA was sequenced and compared with other registered P. ovale isolates. The isolate in this study was a member of the classic type group. The patient was a 44-yr-old male who had worked as a woodcutter in Cote d'Ivoire in tropical West Africa. He was treated with hydroxychloroquine and primaquine and discharged following improvement. In conclusion, P. ovale should be considered as an etiology in the imported malaria in Korea, because the number of travelers to P. ovale endemic regions has recently increased.
Sequence Analysis, DNA ; Polymerase Chain Reaction ; Plasmodium ovale/*genetics ; Male ; Malaria/*diagnosis/etiology ; Humans ; Genes, rRNA ; Adult

Although it is not certain when malaria began to appear in Korea, malaria is believed to have been an endemic disease from ancient times. It was Dr. H. N. Allen (1858-1932) who made the first description and diagnosis of malaria in terms of Western medicine. In his first year report (1885) of Korean Government Hospital he mentioned malaria as the most prevalent disease. Very effective anti-malarial drug quinine was imported and it made great contribution in treating malaria. After Japan had annexed Korea in 1910, policies for public health system were fundamentally revised. Japan assumed control of Korean medical institutions and built high-quality Western hospitals for the health care of Japanese residents. The infectious diseases which were under special surveillance were cholera, typhoid fever, dysentery, typhus, scarlet fever, smallpox, and paratyphoid fever. Among chronic infectious diseases tuberculosis and leprosy were those under special control. Malaria, however, was not one of these specially controlled infectious diseases although it was widely spread throughout the peninsula. But serious studies on malaria were carried out by Japanese medical scientists. In particular, a Japanese parasitologist Kobayasi Harujiro(1884-1969) carried out extensive studies on human parasites, including malaria, in Korea. According to his study, most of the malaria in Korea turned out to be tertian fever. In spite of its high prevalence, malaria did not draw much attention from the colonial authorities and no serious measure was taken since tertian fever is a mild form of malaria caused by Plasmodium vivax and is not so much fatal as tropical malaria caused by P. falciparum. And tertian malaria was easily controlled by taking quinine. Although the majority of malaria in Korea was tertian fever, other types were not absent. Quartan fever was not rarely reported in 1930s. The attitude of colonial authorities toward malaria in Korea was contrasted with that in Taiwan. After Japan had set out to colonize Taiwan as a result of Sino-Japanese war, malaria in Taiwan was a big obstacle to the colonization process. Therefore, a lot of medical scientists were asked to engage the malaria research in order to handle health problems in colonized countries caused by malaria. Unlike the situation in Taiwan, malaria in Korea did not cause a serious health problem as in Taiwan. However, its risk was not negligible. In 1933 there were almost 130,000 malaria patients in Korea and 1,800 patients among them died of malaria. The Japanese Government General took measures to control malaria especially during the 1930s and the number of patients decreased. However, as Japan engaged in the World War II, the general hygienic state of the society worsened and the number of malarial patients increased. The worsened situation remains the same after Liberation (1945) and during the Korean war (1950-53).
Colonialism/history ; History, 19th Century ; History, 20th Century ; Humans ; Korea ; Malaria/diagnosis/drug therapy/*history ; Malaria, Vivax/diagnosis/drug therapy/history ; Microscopy, Polarization ; Plasmodium malariae/isolation & purification ; Plasmodium ovale/isolation & purification ; Plasmodium vivax/isolation & purification ; Quinine/history/therapeutic use

Liver function tests were performed in 61 vivax, 54 malariae and 15 ovale malaria patients who were admitted to Bangkok Hospital for Tropical Diseases between 2001 and 2004. The objective of the study was to evaluate changes in hepatic biochemical indices before and after treatment with artemisinin derivatives. On admission and prior to treatment, hepatic dysfunction was found among the 3 groups. Serum liver function tests and physical examinations were performed weekly during the 28-day follow-up period. Initially elevated serum bilirubin and diminished albumin returned to normal within 2 weeks of treatment. Serum alkaline phosphatase and aminotransferases returned to within normal limits within 3 weeks. We conclude that patients with Plasmodium vivax, P. malariae and P. ovale infections had slightly elevated serum bilirubin, aminotransferase and alkaline phosphatase levels, and hypoalbuminemia. These minor abnormalities returned to normal within a few weeks after treatment with therapies based on artemisinin derivatives.
Treatment Outcome ; Sesquiterpenes/*therapeutic use ; Serum Albumin ; Plasmodium vivax/*drug effects/pathogenicity ; Plasmodium ovale/*drug effects/pathogenicity ; Plasmodium malariae/*drug effects/pathogenicity ; Middle Aged ; Male ; Malaria, Vivax/drug therapy/parasitology/physiopathology ; Malaria/*drug therapy/parasitology/physiopathology ; Liver Function Tests ; Liver/*physiopathology ; Humans ; Female ; Bilirubin/blood ; Artemisinins/*therapeutic use ; Anti-Infective Agents/therapeutic use ; Animals ; Alanine Transaminase/blood ; Adult ; Adolescent

Malaria is a parasitic infection caused by Plasmodium species. Most of the imported malaria in Korea are due to Plasmodium vivax and Plasmodium falciparum, and Plasmodium ovale infections are very rare. Here, we report a case of a 24-year-old American woman who acquired P. ovale while staying in Ghana, West Africa for 5 months in 2010. The patient was diagnosed with P. ovale malaria based on a Wright-Giemsa stained peripheral blood smear, Plasmodium genus-specific real-time PCR, Plasmodium species-specific nested PCR, and sequencing targeting 18S rRNA gene. The strain identified had a very long incubation period of 19-24 months. Blood donors who have malaria with a very long incubation period could be a potential danger for propagating malaria. Therefore, we should identify imported P. ovale infections not only by morphological findings but also by molecular methods for preventing propagation and appropriate treatment.
Blood/parasitology ; DNA, Protozoan/chemistry/genetics ; Female ; Ghana ; Humans ; Korea ; Malaria/*diagnosis/parasitology/*pathology ; Microscopy ; Plasmodium ovale/*isolation & purification ; Polymerase Chain Reaction ; RNA, Ribosomal, 18S/genetics ; Sequence Analysis, DNA ; *Travel ; Young Adult