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Imported falciparum malaria in British troops returning from Kenya
J H Miller1, M Byers, R Whiteoak
1Duchess of Kent's Military Hospital, Catterick Garrison, North Yorks.
Journal of the Royal Army Medical Corps
|October 1, 1994
Summary
Seven British soldiers contracted severe falciparum malaria despite using proguanil/chloroquine prophylaxis during military exercises in Kenya. This highlights potential gaps in malaria prevention compliance and treatment protocols.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Military Health
Background:
- Plasmodium falciparum malaria poses a significant risk to travelers, including military personnel.
- Previous chemoprophylaxis regimens may have limitations in preventing malaria in deployed forces.
Observation:
- Seven out of 150 British soldiers developed symptomatic Plasmodium falciparum malaria after a five-week exercise in central Kenya.
- Soldiers were on proguanil/chloroquine prophylaxis, but compliance was not measured and anti-mosquito measures were not consistently used.
- Symptoms included fever, headache, and gastrointestinal issues, with diagnosis delayed by up to 13 days.
Findings:
- One soldier experienced severe illness with high parasitaemia, requiring intensive care, exchange blood transfusion, and haemofiltration for acute renal failure.
- The study suggests that even in a motivated population, adherence to preventive measures can be suboptimal.
- A change in British Army policy to mefloquine prophylaxis was implemented following this outbreak.
Implications:
- Effective malaria prevention requires not only appropriate chemoprophylaxis but also consistent adherence and complementary measures.
- Simpler prophylactic regimens may improve compliance among military personnel.
- Prompt diagnosis and management are crucial for severe falciparum malaria cases in travelers.