Compared with other plasmodium species which cause human malaria, Plasmodium malariae is considered to be relatively infrequent and milder, although recent reports indicate that its prevalence and impact have been under-estimated. A 23-month-old boy, born and previously living in a refugee camp in Liberia who presented with P. malariae 6 weeks after arrival in the USA, is reported. Despite ostensibly effective anti-malarial treatment with artemether/lumefantrine and two courses of hydrochloroquine, he experienced recurrent parasitaemia, refractory anaemia and splenomegaly over a 6-month period; the symptoms resolved after he received atovaquone/proguanil. It is hypothesised that the recrudescing clinical malaria in this case was related to the long pre-erythrocytic phase unique to P. malariae, and potentially also to a proportion of the parasites being drug-resistant. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.

A/L: artemether/lumefantrine LCM: left costal margin MCV: mean corpuscular volume splenomegaly AT-PG: atovaquone-proguanil HCQ: hydrochloroquine Plasmodium malariae RT-PCR: reverse transcriptase polymerase chain reaction G6PD: glucose-6-phosphate dehydrogenase Malaria Refugee and immigrant health Anaemia

parasitology atovaquone plus proguanil immigrant human recurrent infection Drug Combinations splenomegaly recurrent disease Malaria atovaquone pathology proguanil United States Humans migrant anemia Treatment Outcome Antimalarials male case report preschool child Emigrants and Immigrants Infant antimalarial agent clinical article refugee camp symptom Liberia Communicable Diseases, Imported isolation and purification Recurrence Article Parasitemia communicable disease Artemether, Lumefantrine Drug Combination atovaquone, proguanil drug combination hydroxychloroquine Plasmodium malariae artemether plus benflumetol Plasmodium malariae infection administration and dosage drug combination ferrous sulfate chloroquine Child