Severe Imported Malaria in a Serbian Referral Center

Abstract

Background: World Health Organization estimates that 3.2 billion people are at risk of being infected with malaria. Thus, adequate diagnostic protocols for malaria, especially those aimed at determining disease severity, are paramount in both endemic and non-endemic settings. Methods: We analyzed 22 patients with severe malaria and compared their clinical and laboratory findings with those of patients with non-severe malaria in search of predictors of disease severity. All patients were treated at the Infectious and Tropical Diseases University Hospital, Clinical Centre of Serbia in Belgrade, Serbia from 2000 to 2010. Results: Average age was 44.86 ± 12.33 years and men predominated (95.45%) among patients with severe malaria. Patients with severe malaria were infected with P. falciparum significantly more frequently compared with those with non-severe disease (p=0.047). Jaundice was the most commonly observed feature of severe malaria, followed by anemia and renal failure. A multifactor analysis of variance showed that thrombocytopenia (p=0.05) and high serum TNF-alpha levels (p=0.02) were significantly associated with disease severity. Conclusion: A high index of suspicion for malaria should be maintained when evaluating febrile patients returning from malaria endemic regions. Elevated serum TNF-alpha levels and thrombocytopenia are associated with severe malaria in non-endemic settings.