[Family with malaria: from the asymptomatic to life-threatening]

Five members of a Dutch family of Nigerian origin (three girls aged 1, 6 and 8 years and their parents, mother aged 32 and father aged 41 years), had been infected with Plasmodium falciparum during a visit to Nigeria. The mildest infection could be treated at home with oral medication. The severest case had to be admitted to the paediatric intensive care unit for respiratory support and exchange transfusions. Four patients were treated with quinine. A combination of atovaquone and proguanil was added, resulting in a quick decline of the parasitaemia. Whenever a patient is suspected of malaria, laboratory tests should be carried out immediately and treatment should be started as soon as possible, in order to prevent possible complications. The early recognition of any of the alarm symptoms, for example, lowered consciousness, abnormal respiratory movements, cold extremities, convulsions, hypoglycaemia, severe anaemia and a high parasitaemia, whether at casualty or the general practitioner's surgery is crucial.