Abstract
Due to intercontinental traffic, population migration trends, natural disasters, and climate change, imported malaria remains important to consider in a febrile returning traveler. This study aims to raise awareness about malaria and help European clinicians maintain a working knowledge of this disease by reviewing the most important clinical characteristics in a non-endemic setting. Using medical records, a retrospective study was performed on clinical and laboratory data in order to analyze 103 malaria cases managed at the Clinic for Infectious and Tropical Diseases in Belgrade, from 2000 to 2010. Descriptive statistics, Chi-squared test, Spearman's rank correlation, and analysis of variance were used. Patients were predominantly male (89.3%) with a mean age of 46.66 ± 12.45 years, and most (98.06%) returned from Africa without having taken chemoprophylaxis (72.88%). Fever, arthralgia, myalgia, headache, vomiting, dark urine, and cough were common at presentation. Hepatosplenomegaly, jaundice, neurological and pulmonary findings, and thrombocytopenia were dominant findings on physical and laboratory examinations. Most (73.48%) were infected with P. falciparum. Few patients (17.55%) who were hyperparasitemic had significantly higher values of bilirubin and more frequent neurological complications. All patients were treated with artemisinin-based drug combinations regardless of Plasmodium species. Three (2.9%) patients succumbed to P. falciparum malaria. We suggest a high index of suspicion of malaria be maintained when evaluating febrile patients returning from endemic regions, especially if thrombocytopenia and hemolysis are present. Hyperparasitemia, high bilirubin levels, and neurological symptoms are associated with severe malaria. The importance of adequate malaria chemoprophylaxis cannot be overstated.
Highlights
Due to intercontinental traffic, population migration trends, natural disasters, and climate change, imported malaria remains important to consider in a febrile returning traveler
Relatively uncommon in developed countries, where the disease occurs mainly in travelers who have returned from endemic regions, malaria remains one of the most prevalent human infectious diseases worldwide [2]
The present study examined imported malaria cases treated at the Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, during an 11-year period
Summary
Population migration trends, natural disasters, and climate change, imported malaria remains important to consider in a febrile returning traveler. Conclusion: We suggest a high index of suspicion of malaria be maintained when evaluating febrile patients returning from endemic regions, especially if thrombocytopenia and hemolysis are present. Hyperparasitemia, high bilirubin levels, and neurological symptoms are associated with severe malaria. Most severe cases and deaths from malaria are associated with P. falciparum infection [1]. Thick and thin peripheral blood smears, stained with Giemsa, remain the gold standard for routine clinical diagnosis Malaria smears permit both species identification and quantification of parasites. In non-immune individuals, hyperparasitemia (defined as the infection of ≥ 5% of peripheral blood RBCs on smear examination) is generally associated with severe disease (defined as a disease complicated by multiorgan failure or abnormalities in the patient’s blood or metabolism) [6,7].
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