Abstract
BackgroundIncreasing numbers of aging individuals with chronic co-morbidities travel to regions where falciparum malaria is endemic. Non-communicable diseases are now leading risk factors for death in such countries. Thus, the influence of chronic diseases on the outcome of falciparum malaria is an issue of major importance. Aim of the present study was to assess whether non-communicable diseases increase the risk for severe imported falciparum malaria.MethodsA retrospective observational study of all adult cases with imported falciparum malaria hospitalized between 2001 and 2015 in the tertiary care Charité University Hospital, Berlin, was performed.ResultsA total of 536 adult patients (median age 37 years; 31.3% female) were enrolled. Of these, 329 (61.4%) originated from endemic countries, 207 patients (38.6%) from non-endemic regions. Criteria for severe malaria were fulfilled in 68 (12.7%) cases. With older age, lack of previous malaria episodes, being a tourist, and delayed presentation, well-characterized risk factors were associated with severe malaria in univariate analysis. After adjustment for these potential confounders hypertension (adjusted odds ratio aOR, 3.06 95% confidence interval, CI 1.34–7.02), cardiovascular diseases (aOR, 8.20 95% CI 2.30–29.22), and dyslipidaemia (aOR, 6.08 95% CI 1.13–32.88) were individual diseases associated with severe disease in multivariable logistic regression. Hypertension proved an independent risk factor among individuals of endemic (aOR, 4.83, 95% CI 1.44–16.22) as well as of non-endemic origin (aOR, 3.60 95% CI 1.05–12.35).ConclusionsIn imported falciparum malaria hypertension and its related diseases are risk factors for severe disease.
Highlights
Increasing numbers of aging individuals with chronic co-morbidities travel to regions where falciparum malaria is endemic
The present study aimed to identify co-morbidities associated with severe falciparum malaria imported to Berlin, Germany, in a large adult cohort
Between January 2001 and December 2015 a total of 558 cases of imported falciparum malaria were hospitalized in the Charité University Hospital, Berlin
Summary
Increasing numbers of aging individuals with chronic co-morbidities travel to regions where falciparum malaria is endemic. Aim of the present study was to assess whether non-communicable diseases increase the risk for severe imported falciparum malaria. A nationwide study from Sweden identified diabetes and obesity as two age-related, non-communicable conditions being risk factors for severe imported falciparum malaria [11]. The study gave evidence that hypertension and cardiovascular diseases may lead to more severe courses These observations are of relevance for industrialized nations, where growing numbers of older individuals with co-morbidities travel to countries where malaria is endemic [12]. Hypertension and cardiovascular diseases are the leading risk factors for death in many low and middle-income countries where malaria is endemic [13]. The question how non-communicable diseases in general, and hypertension and cardiovascular diseases in particular, affect the risk for severe malaria, is principally an issue of major importance
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