Severe imported malaria in children in France. A national retrospective study from 1996 to 2005

Abstract

BackgroundsMalaria is a leading cause of imported febrile illnesses in pediatric travelers, but few studies have addressed severe imported pediatric malaria. We aimed to determine the risk factors and the features of imported pediatric severe malaria.MethodsWe conducted a retrospective, descriptive study using the French National Reference Center for Imported Malaria database, in children aged 0–15 years who were hospitalized with a falciparum malaria from January 1st 1996 to December 31th 2005.Uncomplicated and severe cases of falciparum malaria were compared to identify risk factors for severe cases. In the hospitals that reported more than five severe cases during the study period, we evaluated severe cases for prognostic factors and assessed the accuracy WHO criteria for predicting severity. Given the rarity of deaths, adverse outcomes were defined as requiring major therapeutic procedures (MTPs)—e.g., sedation, mechanical ventilation, nasal oxygen therapy, blood transfusions, hemodialysis, fluid resuscitation—or pediatric intensive care unit (PICU) admission.ResultsOf 4150 pediatric malaria cases included in the study, 3299 were uncomplicated and 851 (20.5%) were severe. Only one death was recorded during this period. Predictors for severe falciparum malaria were: age <2 years (OR = 3.2, 95% CI = 2.5–4.0, p <0.0001) and a travel in the Sahelian region (OR = 1.7, 95% CI = 1.3–2.0, p = 0.0001). Of 422 severe malaria cases, a stay in a Sahelian region, lack of chemoprophylaxis, age <2 years or thrombocytopenia <100 x 10^3/mm^3 predicted adverse outcomes. Except for the hyperparasitemia threshold of 4%, the main WHO 2000 criteria for severe malaria reliably predicted adverse outcomes. In our study, the threshold of parasitemia most predictive of a poor outcome was 8%.ConclusionIn imported pediatric malaria, children younger than 2 years deserve particular attention. The main WHO 2000 criteria for severity are accurate, except for the threshold of hyperparasitemia, which should be revised.

Improving statistical power in severe malaria genetic association studies by augmenting phenotypic precision

“…The French national guidelines specifically mention thrombocytopenia (<150,000 per L) for the diagnosis of severe malaria in children who have travelled to a malaria endemic area. In a French paediatric severe malaria series in travellers, almost half had severe thrombocytopenia (<50,000 per L) (Lanneaux et al, 2016;Mornand et al, 2017).…”

Response of imported malaria patients to antimalarial medicines in Sri Lanka following malaria elimination

“…The incidence of severe malaria among imported P . falciparum infections tends to be generally higher than in endemic situations [ 23 , 24 ], this being likely due to the fact that travelers are most often non-immune adults, and also possibly due to delays in diagnosis. In this study however, the time from onset of symptoms to diagnosis was not significantly different between those with uncomplicated and severe P .…”

Conduite à tenir devant un enfant fébrile au retour de voyage

“…Huit cent cinquante et un cas de paludisme grave de l'enfant survenus en France métropolitaine de 1996 à 2005 ont été analysés rétrospectivement [35]. Dans cette série, l'âge de l'enfant et le délai diagnostique étaient inférieurs à ceux observés dans les formes non compliquées.…”