Prospective, National Clinical and Epidemiologic Study on Imported Childhood Malaria in the United Kingdom and the Republic of Ireland

Ladhani, Shamez; Garbash, Mehdi; Whitty, Christopher J M; Chiodini, Peter L.; Aibara, Rashna J; Riordan, F. A. I.; Shingadia, Delane

doi:10.1097/inf.0b013e3181c4d97c

Cited by 35 publications

(37 citation statements)

References 16 publications

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“…It was strongly correlated with cases (OR=11.7 (4.6–30)) and major interventions (OR=9.7 (4.0–23.2)). Thrombocytopenia has repeatedly been linked to severity in studies in countries both with,15 25 and without endemic malaria 7…”

Section: Discussionmentioning

confidence: 99%

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Retrospective study of imported falciparum malaria in French paediatric intensive care units

et al. 2016

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ObjectiveThe World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country.DesignRetrospective case-control study.SettingEight French university hospitals, from 2006 to 2012.PatientsChildren with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110).Main outcome measuresDescriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis.ResultsAltered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001).ConclusionsThe WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care.

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Section: Discussionmentioning

confidence: 99%

“…In a prospective study in the UK and Ireland, only a quarter of the patients with severe imported paediatric Pf malaria required intensive care 7. This calls into question our use of major interventions for severity assessment.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of imported falciparum malaria in French paediatric intensive care units

et al. 2016

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“…Around 70–80% of malaria cases imported into the UK each year are falciparum malaria and most are contracted from visiting sub-Saharan Africa (>90%) 1. In the UK, falciparum malaria is responsible for the most serious cases.…”

Section: Physiological Backgroundmentioning

confidence: 99%

“…There are over 300 new cases of imported paediatric malaria in the UK each year and cases of imported malaria here have been increasing over the last 20 years 1. Malaria in children is particularly difficult to diagnose because the initial presenting features are subtler than in adults.…”

Section: Introductionmentioning

confidence: 99%

How to interpret malaria tests

Dyer

Waterfield

Eisenhut

2016

Arch Dis Child Educ Pract Ed

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There are over 300 new cases of imported paediatric malaria in the UK each year and this has been increasing over the last 20 years. Malaria in children is particularly difficult to diagnose because the initial presenting features are subtler than in adults and do not display the classical presenting features. However, they are also more likely to deteriorate rapidly and to develop severe malaria. The 'gold standard' for ruling out the diagnosis of malaria if clinically suspected is three negative thin and thick blood films, which require serial phlebotomy and the availability of trained technicians. There are now a range of other tests, including rapid diagnostic tests and PCR, as well as clinical features that make the diagnosis more or less likely. We explore the different tests available and whether these might replace the three negative blood films currently needed. We also look at whether we are able to use clinical features to aid the tests used for a diagnosis of imported malaria.

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“…In Europe, the UK has one of the highest burdens of imported malaria with cases peaking in 1995 at 2500 cases followed by a gradual fall to 1370 cases in 2008 5. Children account for 15–20% of all cases and the estimated burden of imported malaria in the UK is 2.8/100 000 children, with P falciparum accounting for over 80% of childhood cases 6 7. Over 90% of all imported malaria cases in the UK occurred among black African children, who acquired their infection in Africa while visiting friends and relatives (so-called VFR) 8.…”

Section: Introductionmentioning

confidence: 99%

UK treatment of malaria

Shingadia

Ladhani

2010

Archives of Disease in Childhood - Education and Practice

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Imported malaria has become an increasingly significant cause of mortality and morbidity in children travelling to areas of the world endemic for malaria. Malaria is one of the commonest imported tropical diseases in the UK, with children accounting for 15-20% of all cases. Over 80% of all cases of malaria are due to Plasmodium falciparum infection, which can cause severe or life-threatening multi-organ disease in children. The clinical features of malaria in children are often non-specific, resulting in missed or delayed diagnosis. Children are more likely than adults to deteriorate rapidly and to develop severe malaria, particularly cerebral malaria. Malaria should be suspected in all children with a history of travel to a malaria-endemic country who present with fever. Diagnosis is usually made with repeated thick and thin blood films. Delays in diagnosis are associated with an increased risk of developing severe malaria and death. Appropriate antimalarial therapy and supportive care should be instituted as soon as possible, particularly in children with severe malaria. Advice should be sought from an appropriate specialist.

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Prospective, National Clinical and Epidemiologic Study on Imported Childhood Malaria in the United Kingdom and the Republic of Ireland

Abstract: Interventions to prevent imported childhood malaria should focus on Black-African families traveling to West Africa, while pediatricians should be offered clearer guidance on the treatment of childhood malaria.

Cited by 35 publications

References 16 publications

Retrospective study of imported falciparum malaria in French paediatric intensive care units

Retrospective study of imported falciparum malaria in French paediatric intensive care units

How to interpret malaria tests

UK treatment of malaria

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