On the return flight to the United States, the girl was very thirsty and drank a large amount of liquid without subsequently urinating either on the plane or in the terminal upon landing. While Carfilzomib on a layover at Dulles International Airport (Dulles, VA), she became unresponsive. She was pronounced dead at a hospital an hour later. Her body was transferred to the Virginia Department of Health Office of the Chief Medical Examiner to perform an autopsy, as required by Virginia law in cases of

sudden unexpected death. On autopsy, she was normally developed and nourished but appeared ill and dehydrated. She had scabbed lesions on the left side of her face and left calf that were consistent with mosquito bites. The internal examination was nonspecific with congestion and edema in various organs and generalized lymphadenopathy. There was no significant trauma, congenital anomaly,

or discrete source of infection to cause her death. Elevated urea nitrogen and creatinine consistent with kidney failure were detected in vitreous sample. Tissues, including brain, heart, liver, and kidney, were submitted to CDC for consultation. Histopathology revealed characteristic intra-erythrocyte parasites suggestive of Plasmodium species. Immunohistochemistry Regorafenib research buy and polymerase chain reaction assays of autopsy tissues and serum confirmed infection with Plasmodium falciparum. Fatal malaria in this child who did not receive chemoprophylaxis or adequate diagnosis and treatment again illustrates the danger of acquiring malaria during travel. Because of the patient’s sudden death outside a health care facility, an autopsy was performed and a true cause of death was established. However, other travelers returning from abroad who become ill or expire may be examined without regard

to travel status.[5] Death may occur after a latency period,[6] Ketotifen and travel status may not be considered as a part of the cause of death. This might be especially true if the patient was found dead or was too ill to provide details on recent travel. There may be other cases where a true cause of death cannot be established because a postmortem examination was not performed. To better inform travelers and the clinicians who provide medical advice to persons before and after travel, it is important to understand factors associated with travel-associated severe illness. Surveillance systems cannot acquire the needed information to better learn from and prevent severe travel-associated illness if the illness is not identified or reported, and illness in patients who die before diagnosis might represent an important gap in our knowledge of these illnesses. GeoSentinel, a worldwide travel-related illness surveillance system, is one of the largest sources of information about illnesses acquired by travelers. GeoSentinel data reported by Freedman and colleagues identified fewer than 20 deaths between 1996 and 2004.