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Pediatric imported malaria in New York: delayed diagnosis
1Department of Pediatrics, University of California, San Diego, USA.
Insights
Imported malaria in children is often misdiagnosed due to nonspecific symptoms, delaying treatment. Travel history is crucial for identifying pediatric malaria cases, especially with chloroquine-resistant strains.
Area of Science:
- Pediatric Infectious Diseases
- Travel Medicine
- Tropical Medicine
Background:
- Imported malaria cases in children present diagnostic challenges.
- Travel to endemic regions is a key risk factor for pediatric malaria.
- Previous studies highlight nonspecific symptoms and delayed diagnosis in children.
Purpose of the Study:
- To review cases of imported malaria in children admitted to Kings County Hospital.
- To identify common clinical presentations, diagnostic challenges, and complications.
- To emphasize the need for a high index of suspicion in at-risk children.
Main Methods:
- Retrospective review of 20 pediatric malaria cases admitted between October 1987 and May 1995.
- Analysis of patient travel history, symptoms, diagnostic findings, and treatment outcomes.
- Microscopic identification of Plasmodium species and assessment of complications.
Main Results:
- Most children traveled from West Africa; none received adequate chemoprophylaxis.
- Common symptoms included fever, chills, and hepatomegaly; diagnosis was delayed in many.
- Plasmodium falciparum was the most common species; complications like hyponatremia and seizures occurred.
- Chloroquine-resistant malaria was prevalent, complicating treatment.
Conclusions:
- Pediatric malaria diagnosis requires a high index of suspicion due to nonspecific symptoms and delayed diagnosis.
- Inadequate chemoprophylaxis in travelers increases malaria risk.
- Effective malaria control in children necessitates prompt diagnosis and appropriate management, considering drug resistance.
Abstract:
The records of 20 children with imported malaria admitted to Kings County Hospital between October 1987 and May 1995 were reviewed. All had a history of recent travel or immigration from a malaria endemic area (West-Africa [16], Central-America [three], and the Caribbean [one]). None of the 10 children with a travel history received appropriate malaria chemoprophylaxis. The most common symptoms and signs were daily fever, chills, and hepatomegaly. Diagnosis was delayed in seven children who were initially felt to have pharyngitis or viral syndrome. Common laboratory findings were anemia and thrombocytopenia. P. falciparum was identified in 70% of the patients. Other species were P. malariae and P. vivax. Complications occurred in six children, hyponatremia in five, seizures in three, and cerebral malaria in one patient. The high incidence of chloroquine-resistant malaria makes chemoprophylaxis difficult in children. The clinical presentation of malaria is nonspecific, and diagnostic delays occur, so a high index of suspicion is needed in children with a travel history.