Abstract
BackgroundThe aim was to assess factors affecting disease severity in imported P. falciparum and non-falciparum malaria.MethodsWe reviewed medical records from 2793/3260 (85.7%) of all episodes notified in Sweden between 1995 and 2015 and performed multivariable logistic regression.ResultsSevere malaria according to WHO 2015 criteria was found in P. falciparum (9.4%), P. vivax (7.7%), P. ovale (5.3%), P. malariae (3.3%), and mixed P. falciparum episodes (21.1%). Factors associated with severe P. falciparum malaria were age <5 years and >40 years, origin in nonendemic country, pregnancy, HIV, region of diagnosis, and health care delay. Moreover, oral treatment of P. falciparum episodes with parasitemia ≥2% without severe signs at presentation was associated with progress to severe malaria with selected criteria. In non-falciparum, age >60 years, health care delay and endemic origin were identified as risk factors for severe disease. Among patients originating in endemic countries, a higher risk for severe malaria, both P. falciparum and non-falciparum, was observed among newly arrived migrants.ConclusionsSevere malaria was observed in P. falciparum and non-falciparum episodes. Current WHO criteria for severe malaria may need optimization to better guide the management of malaria of different species in travelers and migrants in nonendemic areas.
Highlights
The aim was to assess factors affecting disease severity in imported P. falciparum and non-falciparum malaria
All malaria episodes reported between 1 January 1995 and 31 December 2015 in the National Surveillance Database at the Public Health Agency of Sweden, were linked to hospital data through the unique national identity number carried by all residents in Sweden, or the temporary numbers given to visitors or newly arrived migrants upon presentation to hospital
Factors associated with severe P. falciparum malaria were age, pregnancy, HIV infection, origin in nonendemic country, health care delay, and presentation in a region where malaria is less often diagnosed, as previously described [7, 8, 10, 13, 17,18,19]
Summary
The aim was to assess factors affecting disease severity in imported P. falciparum and non-falciparum malaria. Severe malaria according to WHO 2015 criteria was found in P. falciparum (9.4%), P. vivax (7.7%), P. ovale (5.3%), P. malariae (3.3%), and mixed P. falciparum episodes (21.1%). Factors associated with severe P. falciparum malaria were age 40 years, origin in nonendemic country, pregnancy, HIV, region of diagnosis, and health care delay. Oral treatment of P. falciparum episodes with parasitemia ≥2% without severe signs at presentation was associated with progress to severe malaria with selected criteria. In non-falciparum, age >60 years, health care delay and endemic origin were identified as risk factors for severe disease. Among patients originating in endemic countries, a higher risk for severe malaria, both P. falciparum and non-falciparum, was observed among newly arrived migrants.
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