Speciation is necessary to determine whether infection

was due to P. vivax or P. ovale which have latent liver forms (hypnozoites) requiring treatment with primaquine to prevent relapse. As primaquine can cause hemolytic anemia in patients with G6PD deficiency, it is important to rule this out prior to starting treatment with primaquine. In our series, one patient was apparently successfully treated for P. falciparum with primaquine alone, but primaquine is never recommended as single treatment for P. falciparum malaria, although it may be used for prophylaxis in selected patients. Although several patients in our series were treated as outpatients, this cannot be routinely recommended, as serious complications can arise. Severe malaria in children

occurs in less than 20% of cases.14,15,18,21,23,24 Severe malaria is most commonly caused by P. falciparum LBH589 cost and is characterized by neurological involvement (impaired consciousness, seizures, coma), severe anemia, pulmonary edema or acute respiratory distress syndrome, thrombocytopenia, shock, acute renal failure, metabolic acidosis, or hyperparasitemia (>5% parasitized red blood cells). Patients with severe malaria should always be treated with intravenous therapy, either quinidine or artesunate (intravenous artesunate can be obtained for the treatment of severe malaria through an investigational new drug protocol by calling the

CDC malaria hotline at 770-488-7788). In endemic countries, artemisinin combination therapies (artesunate or artemether combined GKT137831 solubility dmso with another antimalarial) are widely used for severe malaria. Artemisinins were discovered in China in 1972 and are the most effective antimalarial compounds available today. In April 2009, Coartem® (artemether–lumefantrine) became the first artemisinin combination therapy to be licensed in the United States. Coartem® is administered orally as six doses over 3 days at 0, 8, 24, 36, 48, and 60 hours; dosing is weight based. Current CDC recommendations for treatment PAK5 of malaria may be found at http://www.cdc.gov/malaria/pdf/treatmenttable.pdf. In summary, this series of cases shows that children with malaria present with a variety of signs and symptoms, have usually received incomplete prophylaxis if any at all, and have been diagnosed up to 1 year after travel. In addition, we compared our data to that published by others and have provided information about treatment and prophylaxis of malaria in the pediatric population. J. Gutman was supported in part by PHS Grant UL1 RR025008 and KL2 RR025009 from the Clinical and Translational Science Award program, National Institutes of Health, National Center for Research Resources. The authors state that they have no conflicts of interest.