Severe Imported Malaria in Adults: Retrospective Study of 20 Cases

González, Ana; Nicolás, Josep M.; Muñóz, José; Castro, Pedro; Mas, J.; Valls, M. E.; Coma, Josep R.; Aibar, Jesús; Gascón, Joaquim

doi:10.4269/ajtmh.2009.08-0637

Cited by 29 publications

(23 citation statements)

References 19 publications

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“…In reports describing malaria at ICU facilities in high-income countries, bacterial coinfections were detected in 24 to 30% of critically ill patients (11,12) and fatal cases (28). In one study, bacteremia was detected in 4.5% of ICU-treated malaria patients; however, 8 of these 18 cases were nosocomial infections (12).…”

Section: Discussionmentioning

confidence: 99%

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Bacterial Coinfections in Travelers with Malaria: Rationale for Antibiotic Therapy

et al. 2013

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e Malaria predisposes children in areas where malaria is endemic to concurrent bacteremia, often with severe outcomes. The importance of bacterial coinfections in patients diagnosed with malaria in nonendemic settings has, however, not been reported. A retrospective analysis of microbiology data was performed in 755 travelers diagnosed with malaria in Sweden. Bacterial cultures from blood and other locations were correlated to clinical outcome and antibiotic treatment. Blood cultures were drawn from 417 (55%) patients (88% of whom were >15 years old), and bacterial isolates of clinical relevance (Salmonella enterica serovar Enteritidis and Escherichia coli) were detected in 2 patients (0.3%). Cultures from other locations (mainly urine, nasopharyngeal, and fecal samples) were obtained from 44% of the patients with 4.9% positivity. Of the 38 patients given antibiotics, 47% had neither severe malaria nor positive cultures and/or radiology signs indicative of treatment. C-reactive protein levels were associated with bacterial infections but had only a fair predictive value. Bacterial coinfections are uncommon among travelers with malaria. These data suggest a weaker association between malaria and bacteremia than previously described in endemic settings and might indicate different patient populations with different pathophysiological mechanisms and microbial environments. The study supports a restrictive antibiotic policy in returning travelers with malaria.

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Section: Discussionmentioning

confidence: 99%

“…Studies of bacterial infections in travelers with malaria can therefore be highly informative since there is little risk of diagnostic misclassification. Although stated in a few reports from intensive care units (ICUs) (11,12), the frequency of bacterial coinfections has not been systematically assessed in travelers with malaria.…”

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confidence: 99%

Bacterial Coinfections in Travelers with Malaria: Rationale for Antibiotic Therapy

et al. 2013

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“…We assume that the patients' age distribution is a consequence of professional migration trends. Average symptom duration prior to hospital admission was approximately seven days (longer in severe cases), a fact observed by other authors [20,21]. Symptoms were often attributed to other, mundane diseases, and/or were intentionally disregarded by both patients and physicians.…”

Section: Discussionmentioning

confidence: 64%

Clinical characteristics of imported malaria: An 11-year experience in a Serbian referral center

Poluga¹,

Milošević²,

Jordovic³

et al. 2016

J Infect Dev Ctries

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Introduction: Due to intercontinental traffic, population migration trends, natural disasters, and climate change, imported malaria remains important to consider in a febrile returning traveler. This study aims to raise awareness about malaria and help European clinicians maintain a working knowledge of this disease by reviewing the most important clinical characteristics in a non-endemic setting. Methodology: Using medical records, a retrospective study was performed on clinical and laboratory data in order to analyze 103 malaria cases managed at the Clinic for Infectious and Tropical Diseases in Belgrade, from 2000 to 2010. Descriptive statistics, Chi-squared test, Spearman's rank correlation, and analysis of variance were used. Results: Patients were predominantly male (89.3%) with a mean age of 46.66 ± 12.45 years, and most (98.06%) returned from Africa without having taken chemoprophylaxis (72.88%). Fever, arthralgia, myalgia, headache, vomiting, dark urine, and cough were common at presentation. Hepatosplenomegaly, jaundice, neurological and pulmonary findings, and thrombocytopenia were dominant findings on physical and laboratory examinations. Most (73.48%) were infected with P. falciparum. Few patients (17.55%) who were hyperparasitemic had significantly higher values of bilirubin and more frequent neurological complications. All patients were treated with artemisinin-based drug combinations regardless of Plasmodium species. Three (2.9%) patients succumbed to P. falciparum malaria. Conclusion: We suggest a high index of suspicion of malaria be maintained when evaluating febrile patients returning from endemic regions, especially if thrombocytopenia and hemolysis are present. Hyperparasitemia, high bilirubin levels, and neurological symptoms are associated with severe malaria. The importance of adequate malaria chemoprophylaxis cannot be overstated.

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“…Haemoglobinuria (also called blackwater fever) and disseminated intravascular coagulation (DIC) occurred in one patient each. According to research by authors from Germany and Spain, hyperbilirubinemia and hyperparasitemia were most commonly associated severe malaria [21,26]. A multicentric study from Thailand showed that jaundice was present in 529 of 1050 patients (50.4%) with severe malaria and a hyperparasitemia was present in 33.3% [27].…”

Section: Discussionmentioning

confidence: 99%