Imported malaria in the 1990s. A report of 59 cases from Houston, Tex

Ta, Moore; Jf, Tomayko; Am, Wierman; Er, Rensimer; Ac, White

doi:10.1001/archfami.3.2.130

Cited by 33 publications

(13 citation statements)

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“…Because malaria is no longer an endemic disease in the US, misdiagnosis of imported malaria patients is common in primary care and emergency settings, especially among children. 14–18 By including patients from the Children's Hospital at Montefiore in our study, we were able to directly compare the clinical characteristics and diagnostic accuracy of adult and pediatric patients with malaria. We found that pediatric patients have a higher rate of misdiagnosis than adults.…”

Section: Discussionmentioning

confidence: 99%

Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria

Goldman‐Yassen

Mony

Arguin

et al. 2016

Pediatric Emergency Care

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Objectives Despite the availability of effective anti-malarial prophylaxis, imported adult and pediatric malaria occurs in the United States and this can pose diagnostic issues. We examined the clinical characteristics and diagnostic challenges of imported malaria requiring adult or pediatric inpatient admission at Montefiore Medical Center (MMC) in the Bronx which provides care for a large population of immigrants from malaria endemic areas. Study Design We conducted a retrospective single center review of patients admitted with a diagnosis of malaria at MMC from 2005 through 2012. We extracted historical, clinical, and laboratory values from the electronic medical record and patient charts. Results We identified 95 patients who were diagnosed and hospitalized with malaria from 2005–2012, 33 (35%) of them children and 17 (18%) with severe malaria. Most patients contracted malaria while visiting friends and relatives (VFR) in West Africa. Only 38% of travelers took prophylaxis, and fewer than half reported taking it as prescribed. Misdiagnosis by emergency room or primary care doctors was observed in almost one quarter of all of the patients. Misdiagnosis occurred significantly more frequently in children (43%) compared to adults (13%) (p=0.002). Pediatric patients were more likely to present with abdominal pain (42% vs 15%, p=0.005). Conclusions Pediatric patients admitted for imported malaria at MMC had a higher rate of misdiagnosis and presented with more gastrointestinal symptoms than hospitalized adults. By describing the clinical characteristics of patients with imported malaria, we hope to improve diagnostic accuracy by healthcare workers and raise awareness that VFRs may require more intensive pre-travel counseling.

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Section: Discussionmentioning

confidence: 99%

Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria

Goldman‐Yassen

Mony

Arguin

et al. 2016

Pediatric Emergency Care

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“…Approximately, 85z of non-immune patients develop malaria symptoms within 30 days of departing from a malaria-endemic area (14,17). However, clinical presentation can vary depending on the malaria-causing species.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the number of cases of imported Plasmodium falciparum malaria, which is the most commonly associated with severe complications, has been increasing over the past decades in Japan (5)(6)(7)(8). Falciparum malaria, if not diagnosed and treated quickly, represents a medical emergency because it is associated with a high risk of acute, severe complications and even death (9)(10)(11)(12)(13)(14)(15)(16). The mortality rate of malaria is estimated to range from less than 1z to 4z; however, the rate could be as high as 20z depending on disease severity, despite progress in intensive care and antimalarial treatment (17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

Reducing the Delay in Initiation of Treatment Improved Clinical Outcomes in Patients with Imported Malaria

Nakayama

Shimizu

2014

Jpn J Infect Dis

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SUMMARY:Although imported malaria poses a grave public health threat in Japan, diagnostic methods and disease management among patients and primary care providers has rarely been reported. Here, we retrospectively reviewed medical records of patients diagnosed with imported malaria in our hospital from 1991 to 2010. Thirty-four malaria cases were identified, corresponding to approximately 2z of the total number of cases in Japan. Falciparum malaria has become predominant in the last 2 decades, and compared with patients in the earlier decade (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000), patients in the latter decade (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) showed significantly shorter delays in consulting medical facilities. The overall hospital delay also tended to be shorter in the latter decade, although delayed referral of patients by a week or more was still observed in more than one-third of the cases. The prevalence of risk factors for severe malaria among patients on the day of the referral visit was also lower in the latter decade. Further, the number of WHO-defined cases of severe malaria was smaller, and the length of the hospital stay was not prolonged during that decade. These findings indicated that a shorter delay in seeking medical treatment could reduce the risks of severe malaria.

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“…Immunocapture RDTs that detect circulating malaria antigens have the potential to improve the accuracy and timeliness of malaria diagnosis, particularly in areas where expertise in microscopy is limited. Given that delays in the diagnosis and institution of treatment for malaria are important and potentially avoidable contributors to malaria-associated mortality (5,19,31), such improvements are important priorities. Although the ICT P.f and ParaSight assays are generally highly sensitive and specific for P. falciparum infection (17,22,28,30,34), they are unable to detect non-falciparum species.…”

Section: Discussionmentioning

confidence: 99%

“…However, in such settings, expertise in malaria diagnosis is often limited and, consequently, diagnostic inaccuracies are a well-recognized problem (2,13,16). Mortality from imported malaria, primarily due to Plasmodium falciparum, is 0.6 to 3.8%, (5,20; H. O. Lobel, C. C. Campbell, and J. M. Roberts, Letter, Lancet i: 873,1985) and is strongly associated with delays in diagnosis and institution of appropriate treatment (5,19,31). Strategies to improve the accuracy and timeliness of malaria diagnosis, particularly where expertise in microscopy is limited, are thus priorities.…”

mentioning

confidence: 99%

Evaluation of the ICT Malaria P.f/P.v and the OptiMal Rapid Diagnostic Tests for Malaria in Febrile Returned Travellers

Playford

Walker

2002

J Clin Microbiol

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Rapid diagnostic tests (RDTs) are less reliant on expert microscopy and have the potential to reduce errors in malaria diagnosis but have not been extensively evaluated in nonimmune persons or in countries where infection is not endemic. We evaluated the ICT P.f/P.v (ICT-Amrad, Sydney, Australia) and OptiMal (Flow Inc., Portland, Oreg.) assays prospectively for the diagnosis of malaria in 158 specimens from 144 febrile returned travellers in Australia by using expert microscopy and PCR as reference standards. Malaria was diagnosed in 93 specimens from 87 patients by expert microscopy, with 3 additional specimens from recently treated patients testing positive for Plasmodium falciparum by PCR. For the diagnosis of asexual-stage P. falciparum malaria, the sensitivity and specificity of the ICT P.f/P.v assay were 97 and 90%, respectively, and those of the OptiMal assay were 85 and 96%, respectively. The ICT P.f/P.v assay missed one infection with a density of 45 parasites/l, whereas the OptiMal assay missed infections up to 2,500/l; below 1,000/l, its sensitivity was only 43%. For the diagnosis of P. vivax malaria, the sensitivity and specificity of the ICT P.f/P.v assay were 44 and 100%, respectively, and those of the OptiMal assay were 80 and 97%, respectively. Both assays missed infections with parasite densities over 5,000/l: up to 10,000/l with the former and 5,300/l with the latter. Despite the high sensitivity of the ICT P.f/P.v assay for P. falciparum malaria, caution is warranted before RDTs are widely adopted for the diagnosis of malaria in nonimmune patients or in countries where malaria is not endemic.

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Imported malaria in the 1990s. A report of 59 cases from Houston, Tex

Cited by 33 publications

References 0 publications

Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria

Higher Rates of Misdiagnosis in Pediatric Patients Versus Adults Hospitalized With Imported Malaria

Reducing the Delay in Initiation of Treatment Improved Clinical Outcomes in Patients with Imported Malaria

Evaluation of the ICT Malaria P.f/P.v and the OptiMal Rapid Diagnostic Tests for Malaria in Febrile Returned Travellers

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