Diagnosis of Malaria in the Febrile Traveler

Je, Svenson; Tw, Gyorkos; Jd, MacLean

doi:10.4269/ajtmh.1995.53.518

Cited by 45 publications

(15 citation statements)

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“…The association of parasitemia and enlarged spleen or parasitemia and thrombopenia were strong, which is in agreement with previous findings. 16 In addition, we found poor general health, absence of abdominal pain, sweating, absence of eosinophilia, anemia, and absence of leucocytosis to be significant predictors of malaria Complementary analysis (data not shown) showed, however, that this criterion was associated with several more objective clinical signs (temperature, diastolic pressure); it may thus still be of some help in diagnosis establishment and management. Elevated white blood cell count is usually considered to be an indication of bacterial infection; it is also a criterion for severe malaria 28 and is even a prognostic factor for fatal outcome.…”

Section: Discussionmentioning

confidence: 90%

“…They found symptom duration, temperature, immune status, fever pattern, and presence of enlarged spleen to be significant variables. 16 A study in the United Kingdom that investigated the causes of imported fever found thrombopenia and hyperbilirubinemia to be useful markers of malaria. 17 The aim of the present study was to identify useful criteria to improve the presumptive diagnosis of imported malaria.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travelers with fever.

D’Acremont

Landry²,

Müeller³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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Abstract. No evidence-based information exists to guide clinicians for giving presumptive treatment to returning travelers when malaria is strongly suspected on clinical grounds but laboratory confirmation is not immediately available or is negative. A prospective study was conducted in travelers or migrants who sought care for fever to identify clinical and laboratory predictors of Plasmodium parasitemia. A total of 336 questionnaires were collected (97 malaria case patients and 239 controls). Multivariate regression analysis showed inadequate prophylaxis, sweating, no abdominal pain, temperature Ն 38°C, poor general health, enlarged spleen, leucocytes Յ 10 × 10 3 /L, platelets < 150 × 10 3 /L, hemoglobin < 12 g/dL, and eosinophils Յ 5% to be associated with parasitemia. Enlarged spleen had the highest positive likelihood ratio for a diagnosis of malaria (13.6), followed by thrombopenia (11.0). Posttest probabilities for malaria were 85% with enlarged spleen and 82% with thrombopenia. A rapid assessment can thus help to decide whether a presumptive treatment should be given or not, especially when the results of the parasitological examination are not immediately available or are uncertain.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travelers with fever.

D’Acremont

Landry²,

Müeller³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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“…Esse fato sugere existir pouca familiaridade de parte dos profissionais de saúde com a doença e suas características clínicas, o que torna a situação preocupante, pois ocorre em região endê-mica, na qual seria obrigatório o diagnóstico presuntivo de malária em todo paciente febril, enfatizando a procedência ou história de viagem desses pacientes para áreas malarí-genas 4,6,12 .…”

Section: Discussionunclassified

A importância do perfil clínico-laboratorial no diagnóstico diferencial entre malária e hepatite aguda viral

Amaral¹,

Albuquerque²,

Pinto³

et al. 2003

J. Pediatr. (Rio J.)

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Objectives: To establish clinical and diagnostic findings of malaria and acute viral hepatitis in children, stressing similarities and differences, so as to enhance the sensitivity of early malaria diagnosis in childhood.Methods: Two groups were studied, each including 30 children between 2 and 10 years of age. The patients presented either primary malaria infection or acute viral hepatitis, confirmed by thick blood film and tests for markers of viral hepatitis A and B. The patients were submitted to the following evaluations: erythrocyte, leucocyte and platelet counts, hemoglobin and hematocrit dosage, hepatic enzymes, urea, creatinine and bilirubin dosage. Clinical and laboratory findings were described for both groups and compared. Individuals with alterations on the physical exam in both groups were compared using Fisher's exact test. Results:Baseline clinical findings were the same in all patients: fever, headache, digestive problems and dark urine. One half of malaria patients did not present the classical malaria signs, but all of them presented fever, differently from patients with hepatitis. In malaria patients, anemia and thrombocytopenia were significantly more frequent than in hepatitis patients. A remarkable increase of bilirubin and hepatic enzyme levels was found in hepatitis patients. Conclusions:A detailed physical examination and a thorough evaluation of non-specific laboratory tests are sufficient to allow the presumptive diagnosis of both malaria and viral hepatitis, and to reinforce the early diagnosis and treatment of malaria. ResumoObjetivos: Destacar o perfil clínico-laboratorial de malária e hepatite aguda viral em dois grupos de crianças, ressaltando semelhanças e diferenças entre os dois quadros; subsidiar o aumento da sensibilidade clínica de presunção diagnóstica precoce de malária na infância.Método: Foram estudados dois grupos de 30 crianças, de dois a dez anos de idade, portadoras de primo infecção malárica ou hepatite viral aguda, confirmados pela pesquisa de plasmódio e pesquisa de marcadores virais de hepatite A e B. As crianças foram submetidas às seguintes avaliações no primeiro dia de atendimento: hemograma, contagem de plaquetas, dosagem de enzimas hepáti-cas, uréia, creatinina e bilirrubinas. Os achados clínicos e laboratoriais foram descritos e comparados entre os dois grupos. Proporções de indivíduos com exames físicos alterados foram comparadas nos dois grupos, pelo teste exato de Fisher.Resultados: A apresentação clínica inicial da doença foi semelhante em todos os pacientes: febre, cefaléia, sintomas digestivos e colúria. Metade dos portadores de malária não apresentou a tríade clássica, apesar de todos terem apresentado febre moderada ou alta, ao contrário dos portadores de hepatite. Na avaliação laboratorial, os portadores de malária apresentaram mais anemia e plaquetopenia quando comparados aos portadores de hepatite. Foram marcantes, nos portadores de hepatite, as elevações de bilirrubinas e enzimas hepáticas.Conclusões: A propedêutica detalhada e a avali...

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“…4,5 Importantly, diagnosis of P. falciparum malaria may be missed or delayed in patients who have malaria years after leaving a malaria-endemic area or who do not report recent visits to malaria-endemic countries. 6 However, early detection of apparently non-imported cases of P. falciparum malaria in Europe is of major public health importance because it enables effective response activities to prevent outbreaks.…”

mentioning

confidence: 99%

Two Cases of Plasmodium falciparum Malaria in the Netherlands without Recent Travel to a Malaria-Endemic Country

Arends

Oosterheert²,

Kraaij-Dirkzwager³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Recently, two patients of African origin were given a diagnosis of Plasmodium falciparum malaria without recent travel to a malaria-endemic country. This observation highlights the importance for clinicians to consider tropical malaria in patients with fever. Possible transmission routes of P. falciparum to these patients will be discussed. From a public health perspective, international collaboration is crucial when potential cases of European autochthonous P. falciparum malaria in Europe re considered.Plasmodium falciparum malaria is an important cause of morbidity and mortality worldwide.1 It is not endemic to Europe, and reported cases in Europe are almost exclusively in travelers returning from malaria-endemic areas.2 Imported infections with P. falciparum (P. falciparum malaria) account for most malaria-related morbidity and mortality in Europe. 3The Netherlands was declared malaria free by the World Health Organization in 1970.The incubation period of P. falciparum malaria is 12-14 days, but longer incubation periods can occur in semi-immune persons and persons taking ineffective malaria prophylaxis, but is typically less than one month.4,5 Importantly, diagnosis of P. falciparum malaria may be missed or delayed in patients who have malaria years after leaving a malaria-endemic area or who do not report recent visits to malaria-endemic countries. 6 However, early detection of apparently non-imported cases of P. falciparum malaria in Europe is of major public health importance because it enables effective response activities to prevent outbreaks. We describe two patients who had not been in malaria-endemic areas for years, but had P. falciparum malaria shortly after returning from countries in southern Europe. Informed consent was obtained from the patients for publication of this report. CASE-PATIENT 1A 23-year-old man from Liberia was seen at an emergency department in the Netherlands because of abdominal pain for three days and a fever of 40 C. Besides an episode of malaria in the past (before 2008), he had no medical history. His travel history indicated a visit to a malaria-endemic country, Liberia, in 2008. Nine days before admission to our hospital, he returned from a four-week holiday in Barcelona, Spain and Treviso, Italy, where he traveled by car. During his travel, he stayed with immigrants who recently returned from Africa, some of whom were sick and had fevers. The patient reported that in both places the living conditions were poor, and many indoor insects, including mosquitoes, were present. No other risk factors for transmission of malaria (e.g., intravenous drug use, blood transfusion, surgical interventions, airport visit) were reported.At a physical examination, he did not appear acutely ill. His blood pressure was 108/55 mm of Hg, his pulse rate was 84 beats/ minute and his temperature was 40 C. He had abdominal tenderness. There were no other abnormalities. Laboratory test results showed hemoglobin level of 8.3 mmol/L, a thrombocyte count of 56 cells/ L and a normal different...

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Diagnosis of Malaria in the Febrile Traveler

Cited by 45 publications

References 0 publications

Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travelers with fever.

Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travelers with fever.

A importância do perfil clínico-laboratorial no diagnóstico diferencial entre malária e hepatite aguda viral

Two Cases of Plasmodium falciparum Malaria in the Netherlands without Recent Travel to a Malaria-Endemic Country

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