FULMINANT CEREBRAL MALARIA IN A SWISS PATIENT K. Mühlethaler 1, E. Scheurer 2, U. Zollinger 2, R. Markwalder 3, X.M. Nguyen 1 1 Institute for Infectious Diseases, 2 Institute of Forensic Medicine, 3 Institute for Pathology University of Berne, Switzerland Objective: Malaria remains the most important parasitic disease worldwide. Falciparum malaria is a medical emergency and requires immediate diagnosis and treatment. Cerebral malaria is a rapidly progressive, potentially fatal complication of Plasmodium falciparum infection. We present this case as a reminder to those colleagues not regularly confronted with such situations. Spleen: congested white and red pulpa, parasites in red blood cells and sinusoids (HE, 250x) Liver: Trophozoites in Kupffer cells and sinusoides (HE, 250x) 2. Postmortem findings (forensic autopsy): massive congestion and edema of brain, lungs and other inner organs spleen enlarged (570 g), with tense, smooth capsule and congested parenchyma of brown-black color Methods / Investigations: 1. Clinical history: 34-year old, white male, spent 8 days close to Mombassa (Kenya) last minute flight  no time to seek pre-travel health advice, departure without arranging chemo prophylaxis 11 days after returning to Switzerland: abrupt onset of fever, chills, malaise and muscle aches 3 days later patient treated for influenza by a general practitioner patient died 4 days afterwards due to multiple organ failure Brain: massive congestion and edema 3. Laboratory diagnosis: EDTA preserved blood was collected postmortem; due to lysis percentage parasitaemia was not done In thick & thin Giemsa stained blood: numerous trophozoites Plasmodium falciparum antigen (HRP2, aldolase) detected (immunochromatographic assay) Histology: brain/liver/spleen: vessels plugged with parasitized red cells, each containing hemozoin pigment Brain: neuron and congested vessels with trophozoites in red blood cells (Giemsa, oil 40x) Brain: capillaries plugged with trophozoites in red blood cells (HE 250x) Conclusion: Necessity of obtaining appropriate pre-travel health advice on malaria prophylaxis before departure to endemic area Malaria should always be considered in the differential diagnosis of patients presenting with fever and/or nonspecific symptoms who have travelled to endemic countries Thick blood smear (Giemsa, 100x) Thin blood smear (Giemsa, 100x) Plasmodium falciparum antigen Correspondence: Dr. K. Muehlethaler, Institute for Infectious Diseases (Clinical Microbiology) University of Berne, CH-3010 Berne, Switzerland Tel. ++41 31 632 9979 E-mail: konrad.muehlethaler@ifik.unibe.ch 10th ICOPA, 4-9 August, 2002 – Vancouver, Canada