Abstract
BackgroundThe study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain.MethodsObservational retrospective study that consisted of a review of all medical files of patients with any malaria test registered at Móstoles University Hospital between April 2013 and April 2018. All suspected malaria cases were confirmed by Plasmodium spp. polymerase chain reaction (PCR).ResultsOf the 328 patients with suspected malaria (53.7% migrant-travellers; 38.7% visitors; 7.6% travellers), 108 cases were confirmed (101 by Plasmodium falciparum), accounting for a 33% positive sample rate. Sixteen cases were diagnosed only by PCR. Patients with malaria, compared to those without, presented predominantly with fever (84% vs. 65%), were older (34 vs. 24 years), sought medical attention earlier (17d vs. 32d), had a greater number of previous malaria episodes (74% vs. 60%), lower levels of platelets (110,500µL vs. 250,000µL), and higher of bilirubin (0.6 mg/dL vs. 0.5 mg/dL). Severe malaria was present in 13 cases; no deaths were recorded. Malaria diagnosis showed a bimodal distribution with two peaks: June to September and November to January.ConclusionsMalaria is still a common diagnosis among febrile patients coming from the tropics specially among migrant travellers. Fever, thrombocytopenia, and/or high bilirubin levels should raise suspicion for this parasitic infection. Prompt diagnosis is crucial to avoid severe cases and deaths.
Highlights
The study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain
Since malaria was declared eradicated from Europe in 1978, cases have largely been imported by international travellers and migrants from endemic regions
Data suggest that due to growing immigration rates towards Europe, a large proportion of imported malaria cases occur among recent immigrants from malariaendemic countries or among settled migrants and their families who travel to malaria-endemic home countries [2, 3]
Summary
The study aimed to analyse the likelihood of imported malaria in people with a suggestive clinical picture and its distinctive characteristics in a hospital in the south of Madrid, Spain. Since malaria was declared eradicated from Europe in 1978, cases have largely been imported by international travellers and migrants from endemic regions. Data suggest that due to growing immigration rates towards Europe, a large proportion of imported malaria cases occur among recent immigrants from malariaendemic countries or among settled migrants and their families who travel to malaria-endemic home countries [2, 3]. Despite its history as a malaria-endemic country, Spain was declared malariafree in 1964, with the last autochthonous case reported in 1961 [6]. Cases of locally acquired malaria have been suspected during the past decade in situations where a history of travel to an endemic zone was absent; local sources of infection could not be identified. Given the presence of some Anopheline species (Anopheles atroparvus) in a variety of regions, the possibility of a new outbreak of autochthonous cases in the near future cannot be excluded [6]
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