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Malaria alert: Local man struck after Cancun visit Resort was thought to be disease-free Thursday, February 17, 2000 By Anita Srikameswaran, Post-Gazette Staff Writer
County health officials yesterday recommended that tourists planning to visit the popular resort of Cancun, Mexico, take drugs to prevent malaria after a local man contracted the disease during a recent trip.
The 46-year-old is the first American known to have contracted the mosquito-borne illness from that part of Mexico, according to Guillermo Cole, spokesman for the Allegheny County Health Department. He described the patient, who has not been named, as being in critical, but stable, condition at a Pittsburgh hospital.
The federal Centers for Disease Control and Prevention, which is looking into the Pittsburgh case as well as two Canadian cases, has not issued a travel advisory. It considers the risk of contracting malaria in Cancun so low that it has not advised tourists to take anti-malarial drugs if they plan to remain within the city. However, it does recommend the treatment for people who intend to leave resort areas and visit outlying areas.
"That's not new," said malaria expert Dr. Monica Pirese of the CDC. "What would be new is if there's [malaria] transmission in the resort area."
Pirese added, "What we've heard so far is that there hasn't been a problem [in Cancun] in terms of an epidemic.
"We are very actively trying to get more information both from Mexico and from the Pan American Health Organization to determine the situation," she said.
Investigators did not reveal whether any of the patients had traveled outside the city.
County health Director Dr. Bruce Dixon suggested that travelers to Cancun obtain a prescription from their doctors for the anti-malarial drug chloroquine. The first pill is taken the week before arrival and once a week while there. One dose per week for a month after returning completes the prevention strategy.
The Cancun Convention and Visitors Bureau counted 167,000 arrivals to the city from the United States between January and March last year. European and Canadian visitors also were common. The Bureau estimated that tourism contributed $640 million to the local economy in that time period.
Malaria is caused by four species of a blood parasite generally called Plasmodium. The disease is common in Africa, south and southeast Asia, and Central and South America.
The parasite reproduces after it is ingested by the female Anopheles mosquito. When the infected mosquito bites a person, the parasite first enters liver cells without producing symptoms. After one to two weeks, the liver cells rupture and release parasites of a developmental stage that are able to invade red blood cells.
The parasites mature further in those cells, which eventually rupture and release more particles that can infect other red cells. If an Anopheles mosquito bites that infected person, it could pick up the parasite and spread the disease.
Symptoms appear with red cell rupture and include fever and chills, nausea, headache and profuse sweating.
Prognosis depends on what kind of Plasmodium parasite is involved in the infection. Mexico's malaria cases are usually caused by a type called plasmodium vivax, Pirese said. Relapses are possible even several years later, but patients usually get better without any residual problems. The Canadians had vivax malaria.
County health officials confirmed that the Pittsburgh patient, however, is infected with Plasmodium falciparum, which produces the most severe disease and can be fatal even if treated. Anemia can be profound and dangerous. Patients may require dialysis because the remnants of the ruptured red blood cells can be toxic to the kidneys.
However, even such serious complications can resolve without producing permanent damage, Pirese said.
According to Cole, all the malaria cases in Allegheny County have come in from other countries. There were six cases last year and none was fatal. There is no risk of malaria spreading locally because, as he put it, "We do not have the mosquito here and the parasite is not here."
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