Malaria in a tertiary hospital in Singapore--clinical presentation, treatment and outcome: an eleven year retrospective review.

Abstract

Malaria remains a global health threat and poses significant health risks even in non-endemic regions like Singapore. A retrospective analysis of 214 patients with smear-positive malaria treated at Singapore General Hospital (SGH) between year 2000 and 2010. One hundred and sixty-seven (78%) patients were male; median age was 35 y (range, 25–52 y). Sixty-four (41%) patients had past history of treated malaria. Seven (4.9%) patients did not travel out of Singapore. One hundred and twenty-seven (76.5%) cases of malaria were acquired in Southeast Asia (SEA) and the Indian subcontinent. There were 127 (59.3%) Plasmodium vivax, 83 (38.8%) Plasmodium falciparum, 1 (0.3%) Plasmodium malariae and 3 (1.4%) mixed infections. Fever was the most common symptom and thrombocytopaenia was the most common laboratory finding. There were 43 severe and 171 uncomplicated cases of malaria, including 8 severe P. vivax cases. Those with severe malaria were older, stayed longer in hospital, had a higher percentage parasitaemia and took longer to clear the parasite. The diagnosis of malaria was suspected at the first contact with healthcare provider in 194 (91.9%) cases. Sixty-one (85.9%) patients with P. falciparum infection received combination anti-malarial therapy and 109 (98.2%) of patients with P. vivax received primaquine for hypnozoite clearance in combination with schizontocidal agent. All the patients survived. In this study, P. vivax was the most common cause of malaria. Severe P. vivax was not uncommon. Cryptic transmission of malaria exists, highlighting the importance of continued vigilance, malaria surveillance and vector control. Early recognition of malaria improved the overall outcome.