Case report: malaria attack in southern Brazil – five-decade relapse, simian malaria or something else?

T his is an account of two episodes of tertian fever separated by 51 years on two continents. The first was Plasmodium vivax malaria. The second may have been because of a long-delayed relapse, a new infection with P. simium, or not being malaria at all. First attack, Borneo 1956 I contracted malaria during a student expedition from Cambridge to British North Borneo (now Sabah, Malaysia) in 1956. It was diagnosed at the time at the Hospital for Tropical Diseases in London as P. vivax. I came down with it in Singapore on our way home in September, where we were stranded short of money for the rest of the return trip. This was before Malaysian independence. I remember clearly having to go to the British High Commission offices downtown in the sweltering afternoon sun wearing a jacket and scarf over a sweater, shirt, and t-shirt, and shivering with fever. A fellow-student (Brian Moser) and I were guests in the house of two physicians, and the first thing they asked me was whether I had taken my prophylaxis. I replied that I had taken Nivaquine (chloroquine sulphate) regularly every Sunday. They agreed that therefore it could not be malaria, and so probably was a case of scrub typhus, although I had no rash or eschar. I was fortunate that Brian managed to arrange a flight back to England in an ex-RAF Lancaster bomber taking freight home, for the donation to the aircrew of our duty-free allowances of cigarettes. I was able to lie on the floor of the aircraft in my sleeping bag and sweat out the tertian attacks during the 5-day flight (8 h each leg, daylight only). I recovered sufficiently in time to eat a hearty meal of frog's legs and watch with the aircrew a belly dancer perform in a nightclub during the last overnight stop, which was in Beirut Á still the 'Paris of the Middle East' in those days. I relapsed after a few days in England, and repeated my story to the doctors at the Hospital for Tropical Diseases in St Pancras, London, claiming it could not be malaria. But, they offered to show me my blood slide, which they said was positive for P. vivax, and admitted me for a 2-week course of Primaquine (an eight-aminoquinoline), which was well tolerated. living in Rio de Janeiro, Brazil. My wife and I were driving in …