Update: Self-Induced Malaria
Associated with Malariotherapy for Lyme Disease -- Texas
In December 1990, the Texas Department of Health (TDH) was
contacted by a man who had recently moved from the northeastern
United States and who was considering malariotherapy for Lyme
disease (LD). He described a 2-year history of unsuccessful
treatment with multiple antibiotics for arthralgias and
palpitations, which had been diagnosed as LD.
TDH personnel discouraged the man from attempting
malariotherapy, emphasizing previously published warnings (1).
Despite these warnings, he obtained blood infected with Plasmodium
vivax from an unknown source in the northeastern United States and
injected himself intravenously with the infected blood on December
20 and 23; he experienced his first febrile episode on December 25.
Thick and thin smears of the patient's blood, obtained by TDH on
January 4, 1991, revealed P. vivax. The patient reported that he
subsequently experienced approximately 10 paroxysms of fever up to
104.9 F (40.5 C) lasting 12 hours. The patient refused all attempts
at medical intervention and treated himself during January 13-16
with chloroquine. No malaria parasites were detected in the
patient's blood when tested on January 22.
The patient reported that the infected blood had been tested
at the source for human immunodeficiency virus, syphilis, and
hepatitis B virus. TDH obtained the remainder of the infected blood
for testing and detected numerous P. vivax parasites.
Reported by: J Rawlings, MPH, JN Perdue, D Perrotta, PhD, D
Simpson, MD, State Epidemiologist, Texas Dept of Health. Bacterial
Zoonoses Br, Div of Vector-Borne Infectious Diseases, and Malaria
Br, Div of Parasitic Diseases, National Center for Infectious
Diseases; Div of Field Epidemiology, Epidemiology Program Office,
CDC.
Editorial Note
Editorial Note: The findings of the TDH investigation suggest a
serious new problem associated with the use of malariotherapy for
treatment of LD--the uncontrolled interstate shipment of infectious
blood in the United States. The infected blood was possibly mailed
from the northeastern United States to Texas and was administered
in the United States rather than, as in a previously reported
episode, in Mexico (1).
The practice of malariotherapy for treating LD has been
emphatically discouraged because there have been no controlled,
well-designed studies showing that this approach is effective (1)
and because of the severe morbidity associated with malaria
infection. In addition, this practice poses a risk for coinfection
with other bloodborne pathogens and for transfusion reactions.
There also may be a small risk for local transmission of malaria in
communities in which persons with parasitemia reside. Finally, the
unauthorized interstate transport of etiologic agents and of blood
and blood products for human use is a violation of federal
regulations.
Malariotherapy for LD is experimental and should be studied
only with stringent safeguards in place, as outlined in the
Declaration of Helsinki (2). In the United States, human
experiments involving new treatments routinely require approval by
the Food and Drug Administration, approval by an institutional
review board for the protection of human subjects, and informed
patient consent.
Physicians throughout the United States should be alert for
cases of self-induced or iatrogenic malaria and are encouraged to
promptly report such cases through state health departments to the
Malaria Branch, Division of Parasitic Diseases, National Center for
Infectious Diseases, CDC; telephone (404) 488-4046.
References
CDC. Imported malaria associated with malariotherapy of Lyme
disease--New Jersey. MMWR 1990;39:873-5.
Page IH. Experiments on people (Commentary). JAMA
1975;232:257-8.
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