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Wirima and Harries report three cases of nonimmune people who lived in or visited Malawi and became ill after Plasmodium falciparum infection but did not have fever.
One patient developed malaise and lethargy, followed seven days later by diarrhea and collapse. Another patient reported malaise and loss of appetite for three days before collapsing. The third patient, who had been treated with chloroquine for fever that developed during a visit to Malawi, lost 20 pounds and had fatigue, anorexia, and pain. All three patients were hospitalized and remained afebrile. They all became hypotensive, and two had altered states of consciousness. All three patients recovered after the diagnosis of malaria and appropriate drug therapy.
The authors stress…