Paludisme

Abstract

Differentiating malaria from other causes of fever is difficult. In France, among patients admitted to the ED with suspected malaria, over 25% have evidence of a thick smear for Plasmodium species, mainly Plasmodium falciparum. Currently accepted clinical variables associated with malaria diagnosis include an age older than 30 years, male gender, immigration to France from an area where malaria is endemic, a visit to sub-Saharan Africa, insufficient antimalaria prophylaxis, fever, chills, absence of diarrhea, a leukocyte count within the reference range, thrombocytopenia, and increased lactate dehydrogenase and bilirubin levels. However, alone or combined, these features have insufficient sensitivity and low specificity for the diagnosis of malaria. Malaria should be suspected in all patients presenting with complaints after a travel to an area where malaria is endemic; such patients should undergo blood microscopy. Successful management of malaria requires rapid diagnosis and initiation of appropriate antimalarial agents. The antimalarial drug and administration route will depend on drug availability and tolerance spectrum, however the increasing role of drug resistance in P. falciparum should be considered. We discuss new therapeutic options and decision making tools for patients hospitalizations.