Malaria in Tunisian Military Personnel after Returning from External Operation

Abstract

Introduction. Malaria had been eliminated in Tunisia since 1979, but there are currently 40 to 50 imported cases annually. Soldiers are no exception as the incidence of imported malaria is increasing in Tunisian military personnel after returning from malaria-endemic area, often in Sub-Saharan Africa. Methods. We retrospectively analyzed the clinical and biological presentations, treatment, and outcomes of 37 Tunisian military personnel hospitalized at the Department of Internal Medicine, the Military Hospital of Tunis, between January 1993 and January 2011, for imported malaria. The clinical and laboratory features were obtained from the medical records and a questionnaire was filled by the patients about the compliance of malaria prophylaxis. Results. Thirty-seven male patients, with a mean age of 41 years, were treated for malaria infection. Twenty-two were due to Plasmodium falciparum. The outcome was favourable for all patients, despite two severe access. The long-term use of chemoprophylaxis has been adopted by only 21 (51%) of expatriate military for daily stresses. Moreover, poor adherence was found in 32 patients. Conclusion. The risk of acquiring malaria infection in Tunisian military personnel can largely be prevented by the regular use of chemoprophylactic drugs combined with protective measures against mosquito bites.

Importation of chloroquine-resistant Plasmodium falciparum by Guatemalan peacekeepers returning from the Democratic Republic of the Congo

“…In 2000, the US military recommended directly observed therapy for malaria chemoprophylaxis for military personnel stationed in highly malaria endemic areas [ 22 , 23 ]. Other preventive practices that have been implemented to reduce the number and impact of malaria infections occurring during military deployments include: equipping troops with permethrin-impregnated uniforms and insect repellent containing DEET; screening military personnel upon return to their home country; training health care providers within the home country on malaria diagnostics and treatment; and administration of a prophylactic course of primaquine at the end of deployment [ 22 - 25 ]. All measures include increases in training of military personnel on the risk of malaria, and proper use of personal protective gear and chemoprophylaxis before, during, and after deployment.…”

The risk of imported malaria in security forces personnel returning from overseas missions in the context of prevention of re-introduction of malaria to Sri Lanka

“…In a hospital-based study that assessed the outcome of soldiers diagnosed with malaria upon return from 1993 to 2011, 37 cases were identified. Chemoprophylaxis was taken by only 21 individuals (21/37, 41 %) and non-adherence was found as the main reason for imported malaria [ 22 ]. The compliance rates reported in this study were better than those reported in studies elsewhere.…”

High imported malaria incidence at a Moroccon military hospital

“…This is comparable to a Tunisian and French studies which P. ovale was the second species found in the military returning from Sub-Saharan Africa. 14,15 The possibility of developing hypnozoites in the liver, which can delay the passage of parasites in blood and delay the onset of symptoms for this species, could lengthen the time to onset of clinical signs. 7 Indeed, one of our patients with infection due to this species had a delay of the onset of symptoms of 6 months.…”