Unusual malaria cases, affecting persons with no recent history of travel to malaria transmission areas, have been reported in Kilner Park, Pretoria (four patients), Theresa Park, Akasia, Pretoria (one patient) and Kempton Park, Ekurhuleni (two patients). Unfortunately, one patient has demised. It is most likely that Anopheles malaria vector mosquitoes, which had been accidentally transported by vehicles from malaria areas, were responsible. This form of disease is called odyssean malaria, also known as airport, suitcase, minibus, or taxi-rank malaria. It is a very rare condition: since 2007, only 72 such cases have been recorded in South Africa, mostly in Gauteng Province.
Understandably, the absence of a travel history often leads to the diagnosis of malaria being delayed, with ‘flu being most commonly assumed as the cause of illness. Experts from the National Institute for Communicable Diseases are assisting the provincial and district Departments of Health to investigate the incidents. No evidence of temporary vector mosquito-breeding in the areas has been found, and the occurrence of these cases does not mean that malaria is spreading to new areas in South Africa. Local residents are advised to take preventive measures against mosquito bites in and around their homes, and to seek medical attention for ‘flu-like illness (mainly fever, chills, headache, muscle and joint pains) that progressively worsens over a short period. Medical practitioners need to be aware of the similarity in symptoms between influenza and early malaria infection, understand that a negative malaria test does not necessarily rule out the diagnosis, and to re-test if illness persists or gets worse. The chance finding of abnormally low platelet counts, in blood samples tested in diagnostic laboratories for unexplained illness, may indicate malaria infection and should be urgently investigated for this possibility.