SOB after travel to SE Asia

 Q: 22 years old male born and raised in the United States recently returned after an eight weeks summer trip from Pakistan. Patient has been brought to ED with shortness of breath. CT-chest showed severe pneumonitis. Patient is reported to comply with all required vaccinations and medications recommended for travel to the Southeast Asia region. Which of the following prophylaxis could be responsible for his symptoms?

A) Doxycycline

B) Mefloquine

C) Hepatitis A vaccine

D) Hepatitis B vaccine

E) Azithromycin  

Answer: B

Malarial prophylaxis is highly recommended while traveling to endemic areas known for malaria such as southeast Asia. Mefloquine is one of the most commonly prescribed malarial prophylaxis. A dreaded complication though rare is Mefloquine-induced pneumonitis which fortunately responds to corticosteroids, and gets resolved with the discontinuation of mefloquine. 

Also, caution should be taken in patients while prescribing Mefloquine with cardiac conduction abnormalities and a history of neurologic and/or psychiatric disorders. It may lead to encephalopathy, sleep disturbances with particular reference to strange dreams. 

Mefloquine is usually started 2 weeks prior to the departure date. Symptoms should be watched closely during this period.

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References:

1. Chen LH, Wilson ME, Schlagenhauf P. Controversies and misconceptions in malaria chemoprophylaxis for travelers. JAMA 2007; 297:2251. 

2. Meier CR, Wilcock K, Jick SS. The risk of severe depression, psychosis or panic attacks with prophylactic antimalarials. Drug Saf 2004; 27:203. 

3. Katsenos S, Psathakis K, Nikolopoulou MI, Constantopoulos SH. Mefloquine-induced eosinophilic pneumonia. Pharmacotherapy 2007; 27:1767. 

4. Soentjens P, Delanote M, Van Gompel A. Mefloquine-induced pneumonitis. J Travel Med 2006; 13:172.