If so, it would offer a powerful tool to select recently exposed patients for early treatment with artemisinin derivatives because praziquantel treatment before schistosome maturation

is ineffective.[15] The authors state they have no conflicts of interest to declare. “
“We report four cases of asymptomatic Plasmodium falciparum malaria in pregnant African women. They had immigrated to Finland 3 to 13 months earlier. The disease was revealed only by anemia. SP600125 The diagnosis relied on blood smear which showed a parasitemia <0.2% in three cases. Medical personnel should be informed about the possibility of afebrile forms of malaria in pregnant women even months after immigration. Very low levels of parasitemia may call for a more sensitive diagnostic approach such as polymerase chain reaction. In countries without indigenous malaria, medical education stresses the peril of febrile Plasmodium falciparum malaria. While this is the case in non-immune persons, such as travelers, P falciparum infection presents in semi-immune persons mostly as a chronic disease with only rare bouts of fever, if any. Women immigrating from endemic to non-endemic 3Methyladenine countries with no malaria transmission

are no longer considered to be at risk for the disease. The fact that they may still have persistent parasitemia after departing from their native country is not widely recognized. This report presents four afebrile pregnant women with P falciparum malaria who had emigrated from endemic countries 3 to 13 months earlier. We believe they represent only the tip of the

iceberg, and the diagnoses are often missed in pregnant immigrants: in our patients the only sign was anemia found in a routine check-up. The first patient was a 32-year-old woman from Cameroon who had not traveled abroad since moving to Finland in July 2002. While in Cameroon, she had had malaria several times, most recently 1 year before immigration. Early in her pregnancy, in June 2003, she was found to be anemic (Hb 93 g/L) and started taking iron supplements. Despite the treatment, her hemoglobin decreased to 84 g/L, and she learn more was referred to a hematologist. Her blood smear, obtained 13 months after arrival, was positive for P falciparum ring forms with a parasitemia of <0.1%. After 7 days of oral treatment with quinine, the anemia subsided. The second patient was a 23-year-old woman who had immigrated to Finland in September 2007 from the Democratic Republic of the Congo, and had not traveled abroad since then. She had been treated for malaria about 1 year before emigrating. After living in Finland for 6 months, in week 29 of her pregnancy, she was referred to a maternity hospital owing to anemia with Hb 72 g/L. Microscopy was positive for P falciparum with a parasitemia of <0.1%. The patient was treated with oral quinine for 10 days and her anemia subsided.