Historical review: does stress provoke Plasmodium falciparum recrudescence?

Plasmodium falciparum, unlike P. vivax, must maintain infection in the blood/bone marrow over many months/years in order to bridge periods between transmission periods. Asymptomatic parasitemia at very low concentrations is now known to be quite common due to molecular detection methods. Old tropical medicine texts commonly list many stressful events stated to provoke recrudescent falciparum parasitemia such as fatigue, heat/chill, trauma/surgery, famine/war, transit between areas and other febrile illness. The older literature is reviewed to discover the factual basis of such varied reports since they have not been recently confirmed. It seems likely that human stress sometimes induces falciparum recrudescence of an otherwise asymptomatic infection. Reproducing such observations today has been radically altered as malaria chemotherapy has evolved from suppressive quinine to curative artemisinin combinations. Host stress-provoked recrudescence may be part of P. falciparum's survival strategy.