Abstract
Little is known about severe imported Plasmodium falciparum malaria in industrialized countries where the disease is not endemic because most studies have been case reports or have included <200 patients. To identify factors independently associated with the severity of P. falciparum, we conducted a retrospective study using surveillance data obtained from 21,888 P. falciparum patients in France during 1996–2003; 832 were classified as having severe malaria. The global case-fatality rate was 0.4% and the rate of severe malaria was ≈3.8%. Factors independently associated with severe imported P. falciparum malaria were older age, European origin, travel to eastern Africa, absence of chemoprophylaxis, initial visit to a general practitioner, time to diagnosis of 4 to 12 days, and diagnosis during the fall–winter season. Pretravel advice should take into account these factors and promote the use of antimalarial chemoprophylaxis for every traveler, with a particular focus on nonimmune travelers and elderly persons.
Highlights
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases
The annual number of malaria cases reported by the network increased to ≈3,000 cases up to 1999–2000 and incidence began to regularly decrease
With a mean of >4,000 cases per year during the study period, France is the country reporting the highest number of imported malaria cases; >80% of cases are caused by P. falciparum, the species responsible for almost all severe cases and death in travelers
Summary
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. LLC is accredited by the ACCME to provide continuing medical education for physicians. LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. All other clinicians completing this activity will be issued a certificate of participation To participate in this journal CME activity: [1] review the learning objectives and author disclosures; [2] study the education content; [3] take the post-test and/or complete the evaluation at www.medscape.org/journal/eid; [4] view/print certificate. Disclosure: Beverly Merritt has disclosed no relevant financial relationships. MD, has disclosed no relevant financial relationships
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