Le paludisme d’importation au CHU de Bordeaux de 2000 à 2007: épidémiologie, prise en charge et comparaison avec les données nationales

Abstract

In Western countries, France accounts for the most concerned by imported malaria. The objective of the present study was to describe the epidemiological and clinical features of imported malaria in adults attending the University Hospital Center (UHC) ofBordeaux and to compare these findings with the French national epidemiological data. A retrospective analysis of all patients aged over 15 years with parasitologically confirmed malaria in patients recruited between January 1, 2000 and December 31, 2007 has been performed. A total of 526 cases fitted the inclusion criteria with two-thirds of males and a mean age of 37 years. Patients were less frequently native from sub-Saharan Africa (SA), Madagascar, and Comoros than those from the French national data register (29 versus 72%). Hence, SA was the main destination (2/3 travelling to Western Africa and 1/3 to Central Africa). The recourse to an adequate chemoprophylaxis (CPL) for stays in areas of chemoresistance had been reported in about one-third of the patients. From these, two thirds were noncompliant. The recourse to chloroquine less frequent (6 versus 24%) among patients from Bordeaux compared to those from the national data register whereas the recourse to mosquito net use more frequent in patients from Bordeaux (36 versus 3%). Plasmodium falciparum was the main infective species.Malaria was more frequently associated with hospitalization (89 versus 71%) and with severe disease (9 versus 4%) in Bordeaux than in national data register. Two deaths were declared. Atovaquone-proguanil (AP) combination therapy wasmore frequently used in Bordeaux compared to the national data (64 versus 20%). This AP combination treatment was the most frequently prescribed for uncomplicated malaria, whereas intravenous quinine was mainly used for complicated malaria and for patients with vomiting. The lack of CPL, the diagnosis or therapeutic delay, and the lethality of malaria among travellers infected by malaria imported from SA argue for the implementation of continuing medical training and health education targeted at travellers from France to high malaria-endemic areas such as SA, Madagascar, and Comoros.

Atovaquone-proguanil in the treatment of imported uncomplicated Plasmodium falciparum malaria: a prospective observational study of 553 cases

“…This ‘real life condition’ prospective, observational study of 553 patients treated by AP for uncomplicated P. falciparum malaria seems to be the largest series assessing the use of AP in the field of imported malaria. Patient profile (mostly young male adults of African origin living in Europe and infected in West Africa) are similar to those observed in the majority of studies on imported malaria [ 18 - 24 , 26 - 28 ]. The high percentage of HIV-infected patients (4.4%) observed in the study may be explained by the fact that the majority of patients are of African origin and because the nine recruiting centres are travel clinics linked to infectious diseases departments where a majority of the HIV patients living in Paris area are followed.…”

“…However, these results might not be valid in the case of imported malaria, due to epidemiological and biological differences (i e, study conditions, immune status, parasitaemia, heterogeneity of parasite strains, perception of side effects). Most of the studies comparing AP to other drugs were performed in endemic countries, and few observational or retrospective studies from non endemic countries have been published, amongst which only was a comparative trial, yet with a limited number of subjects has been published [ 18 - 24 ]. A recent international, prospective, observational study analysed a large cohort (504 cases) of imported Plasmodium falciparum malaria cases.…”