A retrospective review of malaria cases seen in a non-endemic area of South Africa

Abstract

Malaria is a risk for travelers to endemic areas. We describe the diagnosis and treatment of malaria in Pretoria, a non-endemic area in South Africa. Records of specimens submitted to the medical microbiology laboratory for malaria investigations over 3 years were reviewed with follow up of hospital records for positive specimens for clinical data. The laboratory performs malaria smears and uses HRP2-Ag testing for rapid diagnosis of Plasmodium falciparum. A total of 516 specimens were received, with a 211/516 (41%) malaria smear positive rate. The number of malaria positive specimens has been increasing overtime and this increase was statistically significant in children [p=0.005]. HRP2-Ag testing was done on 430 specimens with124/430 (29%) being positive, of which 10/124 (8%) were smear negative, giving 98% sensitivity. Hospital records for 198/211 (94%) smear positive cases showed that 190/198 (96%) of the patients had a travel history with 170/190 (71%) having traveled to Mozambique, a malaria endemic country. Most patients presented with uncomplicated malaria; the CFR was 4/198 (2%). Treatment mainly followed South African national guidelines. Imported malaria is increasingly being diagnosed in returning travelers, especially from Mozambique. Rapid antigen tests remain useful for the diagnosis of malaria in non-endemic areas.