ABSTRACT

The most common clinical features of very contagious Ebola virus disease are fever, fatigue, vomiting, diarrhea, loss of appetite and headache whereas leucopenia, thrombocytopenia and elevated liver enzymes are the most promi-nent laboratory results. The other common endemic infectious diseases in sub-Saharan Africa where the last Ebola outbreak has been occurred are yellow fever, malaria and enteric fever. In this report, chloroquine-resistant uncomplicated P. falciparum malaria diagnosed by thin-thick blood smear and successfully treated with artemether-lumefantrine therapy were described. The patient, who came from Africa during the period of Ebola outbreak in 2014, admitted to our emergency service with the complaints of chilly fever, nausea, vomiting, loss of appetite, cough, headache and body aches. The patient was in the capital city named Malabo located on Bioko Island of Republic of Equatorial Guinea for a month because of business. He did not have any symptoms during that time in Africa. The complaints began within a week returning from trip and symptomatic therapy was given by different health centers. He neither had taken malaria chemoprophylaxis regularly nor had avoided mosquito bites while in Africa despite the recommendations of Travel Health Center. The patient was conscious, cooperated and oriented. The signs of meningeal irritation were negative. Physical examination was normal except fever and tachycardia. His past medical history was unremarkable. Preliminary laboratory results revealed leucopenia, throm-bocytopenia, mildly elevated both aminotransferases and creatinine. Urine analysis revealed mild proteinuria, micros-copic hematuria and glucosuria. The symptoms, physical examination and preliminary laboratory test results were not enough to make a focal infection diagnosis. However the differential diagnosis between malaria and Ebola virus dise-ase should be done urgently in a feverish patient returned from Africa during Ebola outbreak period. P. falciparum ring and headphone appearance forms of trophozoites were seen in Giemsa stained thin and thick blood smears. Although Republic of Equatorial Guinea is a country having boundaries to the Ebola outbreak countries; there was no notified Ebola case during that time. The definitive diagnosis of malaria was done when this information and malaria trophozoites in blood smear were considered as a whole.The case treated successfully with an artemisinin-based com-bination named arthemether-lumefantrine as because P. falciparum malaria is chloroquinine resistant in the Republic of Equatorial Guinea. Imported malaria cases will continue to increase in the future in our country as because to acce-lerating international travel due to business or tourism. Endemic and epidemic infectious diseases pertaining to travel itinerary in a feverish patient returned from travel sho-uld be considered in the differential diagnosis.