Epidemiological features and case management practices of imported malaria in northern Italy 1991–1995

Abstract

SummaryWe report the results of a retrospective analysis of the clinical charts of imported malaria cases notified during the period 1991-95 in the Lombardy region of northern Italy. We analysed 694 admissions related to 683 individuals. The proportion of immigrants increased during the observation period from 34.4% in 1991 to 59.9% in 1995 (P ϭ 0.002). P. falciparum was the causative species in 534 cases (78.2%), and 591 (90.1%) of 656 cases with a full travel history had travelled to Africa. Information on chemoprophylaxis was available in 604 cases: 429 (71.0%) reported no drug intake, 140 (23.2%) an incomplete, and 35 (5.8%) a complete chemoprophylactic course. The proportion of subjects who had initiated malaria chemoprophylaxis was significantly lower among immigrants (7.4%) than nonimmigrants (50.2%) (P Ͻ 0.001). Severe disease was diagnosed in 26 (4.7%) of 551 cases of falciparum malaria, with a significantly lower incidence among immigrants (1.3% vs. 9.2%; P Ͻ 0.001). Eight deaths were recorded, all among nonimmigrants, whose fatality rate was significantly higher (P ϭ 0.02). Mefloquine treatment of cases of uncomplicated falciparum malaria was associated with a significantly shorter fever clearance time (2.8 days Ϯ 1.5 vs. 3.5 days Ϯ 1.9; P Ͻ 0.001) and mean hospital stay (5.9 days Ϯ 4.4 vs. 8.3 days Ϯ 5.1; P Ͻ 0.001) compared to quinine treatment.

Severe Imported Malaria in a Serbian Referral Center

“…A retrospective study that had been conducted at The University Hospital in Heidelberg, Germany and included 122 patients with falciparum malaria, showed that thrombocytopenia was a significant predictor of severe malaria [21]. These findings were corroborated by other authors [20,38]. In severe malaria, the concentrations of proinflammatory cytokines such as TNF-α, IL-1, IL-6, and IL-12 are elevated [39].…”

Imported Malaria in Children in Industrialized Countries, 1992–2002

“…Use of chemoprophylaxis is recommended for all children who travel to high-risk malaria-endemic areas (34). Several studies have indicated, however, that correct use of and adherence to chemoprophylaxis is low (13,16,(35)(36)(37)(38).…”

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

“…Several studies have been conducted in semi-immune children in endemic areas to improve the diagnosis of malaria in the absence of microscopy, [22][23][24][25][26][27] but their conclusions are not readily applicable to nonimmune travelers returning from the tropics with fever. From the purely descriptive studies in nonimmune travelers or migrants, [6][7][8][9][10][11][12][13][14][15] we expected inadequate prophylaxis, measured fever, enlarged spleen, and thrombopenia to be important predictors of malaria. These parameters were confirmed in our study.…”

“…Reports on imported malaria generally describe the clinical presentation of hospitalized patients in centers that specialized in tropical medicine, [6][7][8][9][10][11][12][13][14][15] although no study was specifically designed to estimate the predictive values of the different clinical characteristics. One study in Canada investigated retrospectively whether the clinical presentation or the laboratory parameters could be used for predicting malaria infection in febrile travelers.…”