Reactivation of plasmodium malariae infection in a Trinidadian man after neurosurgery

Malaria often presents as an acute febrile illness with fever, headache, rigors, anemia, and splenomegaly. The only malaria parasite associated with cerebral complications, Plasmodium falciparum usually blocks cerebral capillaries because of its endothelial adhesiveness. Infections with P. marlariae can persist for decades and are associated with splenomegaly and the nephrotic syndrome but not with cerebral complications. We describe P. malariae infection that was reactivated after neurosurgery after decades of latency. Infections with P. malariae may be asymptomatic and can be reactivated decades after the initial infection. The epidemiologic significance of asymptomatic cases of P. malariae infection has been well documented during outbreaks in Trinidad and Tobago and Grenada. Most of the symptomatic cases were detected by microscopial analysis, whereas the asymptomatic cases were diagnosed with the use of immunofluorescence antibody assays. Subclinical infections in humans may serve as the source of the protozoa in mosquitoes. Consequently, it is recommended that a sensitive technique that is based on the polymerase chain reaction be used to screen persons for persistent malaria infections, especially those who live in regions where the disease was once common but has since been eradicated