Abstract
BackgroundThe western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones.MethodsRetrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination.ResultsThree hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM.ConclusionsImported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk.Graphical
Highlights
The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work
The vast majority of malaria cases in our area occur in sub-Saharan immigrants, mostly in VFR migrants who permanently reside in Spain and travel back and forth to their homeland for holidays and so on
The rise in the number of cases parallels the increase in the number of immigrants living in our area
Summary
The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. Around 90% of them come from sub-Saharan Africa and are mainly diagnosed in newly arrived migrants or in resident migrants traveling back to their home-countries to visit friends and relatives (VFR, visiting friends and relatives). In this last group of travelers, risk perception for malaria is low and preventive measures are usually not followed [3,4,5,6]. Most of the cases reported in Europe are patients with microscopic malaria (MM), submicroscopic malaria (SMM) [7,8,9] is present. SMM may reach a prevalence of near 9% in asymptomatic patients from endemic areas [7] even though figures are probably underestimated because of the absence of symptoms and the fact that molecular diagnosis is not routinely employed
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