Weekly

October 04, 1991 / 40(39);665-666

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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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