Plasmodium vivax Infection among Tourists
to Puerto Vallarta and Acapulco, Mexico -- New Mexico, Texas
New Mexico. On January 17, 1985, a husband and wife from Santa
Fe, New Mexico, flew to Puerto Vallarta, Mexico. They stayed at a
beachfront resort hotel within the city limits of Puerto Vallarta
for
4 days, after which they returned to the United States. On January
31, within a 12-hour period, the couple had onset of an illness
characterized by fever, chills, drenching sweats, malaise, and
headache. On February 2, when the wife sought medical attention,
she
had a fever of 38.9 C (102 F) and a mild tachycardia. Blood smears
examined on the wife on February 3 and on the husband on February 4
revealed Plasmodium vivax. Both were successfully treated with
chloroquine and primaquine. Interviews with the patients revealed
no
risk factors for acquiring malaria other than their recent vacation
in
Puerto Vallarta. Neither patient had traveled outside the United
States in the past 5 years; neither had a history of blood
transfusion
or intravenous drug use. The couple did not leave the hotel
grounds
during their stay in Puerto Vallarta other than to travel to and
from
the airport. They had eaten their evening meal outdoors at the
hotel
on two occasions and had slept in a room with unscreened open
windows. Both stated that they had been bitten by mosquitoes on
multiple occasions.
Texas. On May 31, 1985, nine members of a family from San
Antonio, Texas, flew to Acapulco, Mexico. They stayed in a rented
villa situated on a cliff overlooking Acapulco Bay in a resort area
12
miles from the center of the city, where they remained until they
returned to the United States on June 5. Between June 5 and June
17,
six of the nine family members experienced febrile illnesses. On
June
16, the first family member who became ill was diagnosed as having
malaria after blood smears revealed P. vivax. Subsequently, blood
smears on the other five ill family members also demonstrated P.
vivax. All six were successfully treated with chloroquine and
primaquine. Two of the three who have remained well have had
negative
blood smears. None of the family members had traveled outside the
United States in the previous 5 years; none had any history of
blood
transfusion or intravenous drug use. The family had not left the
villa other than to travel to and from downtown Acapulco and the
airport. They ate their evening meals on an unscreened porch at
the
villa, where they experienced frequent mosquito bites.
Subsequently, CDC has been notified of four additional
unrelated
Texas residents who were infected by P. vivax during May and June
in
the same resort area as the family described above.
Reported by L Nims, MS, HR Landmann, MD, BM Greenfield, MD, D
Gregory,
MD, HC Anderson, MD, B Baker, MT, Santa Fe, L Davis, MD, Dept of
Neurology, University of New Mexico School of Medicine; CM Sewell,
DrPH, HF Hull, MD, State Epidemiologist, New Mexico Health and
Environment Dept; D Allegra, MD, R Park, MD, W Dickenson, MT,
Village
Oak Hospital, F Buckwold, MD, Baptist Medical Center, San Antonio,
T
Gustafson, MD, J Perdue, CE Alexander, MD, State Epidemiologist,
Texas
Dept of Health; Malaria Br, Div of Parasitic Diseases, Center for
Infectious Diseases, Div of Quarantine, Center for Prevention Svcs,
CDC.
Editorial Note
Editorial Note: Transmission of P. vivax is reported to occur in
the
rural areas of both Jalisco and Guerrero, the states in which
Puerto
Vallarta and Acapulco are located (1). Current CDC recommendations
indicate that there is no risk of malaria in major tourist resorts
along the Pacific and Gulf of Mexico coasts (2), and the National
Malaria Service of Mexico has not received any reports of malaria
in
Mexican or foreign tourists to these areas. However, these cases
among U.S. travelers suggest that malaria can be transmitted in
such
areas, albeit rarely, and should be considered as a possible cause
of
a febrile illness in persons who have recently returned from resort
vacations in Pacific coastal areas of Mexico.
While chemoprophylaxis is not recommended for travelers to
these
areas, physicians who advise patients before travel to Mexico
should
emphasize the importance of measures to reduce contact with
mosquitoes
during evening and nighttime hours, such as remaining in
well-screened
areas when possible, wearing protective clothes that cover most of
the
body, and using insect repellent on exposed areas of skin.
Editorial Note: Photosensitivity of the skin refers to an abnormal
reaction of the skin to light. This abnormal reaction results from
exposure to certain therapeutic or chemical agents. Exposure may
occur when the offending agent is either ingested or applied
topically. The reaction occurs only after an exposed individual is
subjected to ultraviolet or visible light. In most cases, the
offending agents do not act as contact irritants by themselves;
they
are harmless to skin in the absence of exposure to light.
Photosensitivity reactions are classified as either
photoallergic
or phototoxic. Photoallergy involves the immune system. The
offending agent, acting as a hapten, absorbs radiation, becomes
activated, and reacts with protein(s) within the skin to form an
antigen(s). This photoantigen is immunologically processed and
manifests itself as an ordinary delayed hypersensitivity response.
The patient with photoallergy has eczematous or papulovesicular
eruptions.
References
Subsecretaria de Servicios de Salud. Situacion epidemiologica
del
paludismo en Mexico, 1983. Epidemiologia Boletin, 1984;4:162-8.
CDC. Health information for international travel 1984.
Atlanta,
Georgia: U.S. Department of Health and Human Services, PHS,
Centers for Disease Control, Division of Quarantine, 1984; HHS
publication no. (CDC)84-8280;11-58.
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