Drs Dorsey and colleagues1 are to be commended for their recent article reemphasizing physician difficulties in the diagnosis of imported malaria. As the authors noted, clinicians should inquire about all previous travel, even if it was months in the past, to consider malaria as a diagnostic possibility.
From the physician's standpoint, there are 3 major diagnostic problems with malaria. First is prophylaxis. In my experience, and in that of my physician colleagues at our travel clinic, failure to take malaria prophylaxis properly is common among patients returning from abroad. Our most recent case of mild malaria was in a young woman returning from West Africa with Plasmodium falciparum malaria. She had taken mefloquine prophylaxis 1 week prior to travel and for the duration of her travel, but she failed to continue her prophylaxis during the postexposure period. In our experience, the commonest cause of failure of malarial prophylaxis is failure to complete the postexposure treatment.