Geraghty et al describe a case of severe falciparum malaria in a patient being treated with infliximab for rheumatoid arthritis. Infliximab is an antibody to tumor necrosis factor (TNF-alpha) and its has been associated with a number of serious opportunistic infections.
Features of overwhelming falciparum malaria:
(1) cerebral malaria with depressed mental status and seizures
(2) parasitemia > 50%
(3) severe anemia and thrombocytopenia
Recommendations for a patient receiving an antibody to TNF-alpha:
(1) Avoid regions where falciparum malaria can be acquired.
(2) Take extensive precautions against exposure to mosquitoes (repellants, mosquito nets at night, etc.)
(3) Take suitable chemoprophylaxis against malaria.
(4) Monitor health during and after the trip, with prompt medical evaluation of fever or other symptoms.
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