Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast

Abstract

BackgroundAlthough malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject.MethodsA retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011.ResultsAmongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections.ConclusionsSevere malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.

Severe imported malaria in a Brazilian non-endemic region: a permanent alert for travelers and health teams

“…6 However, in non-endemic areas, mainly due to the lack of previous immunity of the inhabitants and delayed diagnosis, this rate increases, and the occurrence of severe malaria in all age groups becomes a real concern. [5][6][7] The presence of mixed P. vivax and P. falciparum infections and the clinical course with several complications are the main aspects that need attention in the first case. Studies that compare the clinical and laboratory aspects between P. vivax or P. falciparum single infection and double infection suggest that coinfection is associated with different outcomes, including a lower probability of developing complications.…”

Pharmacotherapy follow-up: Role in active malaria surveillance in a travel medicine centre outside the transmission area in Brazil

“…In this study, median follow‐up time over than 28 days allowed confirmation of 20% of vivax malaria relapses, as these patients had not returned to transmission areas. Studies on imported malaria in Brazilian areas without transmission have reported relapse rates varying from 12.6 to 39.6% . However, these values should not be compared due to differences in study design and methods of monitoring antimalarial treatment.…”

“…Studies on imported malaria in Brazilian areas without transmission have reported relapse rates varying from 12.6 to 39.6%. 15,16,47 However, these values should not be compared due to differences in study design and methods of mon- 2.94 times greater for patients with no primaquine dosing adjustments than for patients with primaquine dose adjustments. 15 A small sample size is one of the limitations of this study, which was due to the non-endemic study area.…”

Clustering symptoms of non-severe malaria in semi-immune Amazonian patients

“…For military personnel working in endemic areas, diarrhea was reported to be at a 50% prevalence ( He et al, 2013 ). Even in Brazilian travelers returning from the Amazon, diarrhea was reported at higher frequencies (67% for falciparum and 55% for vivax cases) ( Dos-Santos et al, 2014 ). Thus, diarrhea can be related to parasitemia and/or to acquired immunity.…”