Delay in diagnosis of imported Plasmodium falciparum malaria in children

Area of Science:

• Pediatric Emergency Medicine
• Infectious Diseases
• Travel Medicine

Background:

• Imported malaria, particularly Plasmodium falciparum, poses a diagnostic challenge in non-endemic settings.
• Prompt diagnosis is crucial for effective treatment and preventing severe outcomes in pediatric patients.

Purpose of the Study:

• To prospectively evaluate the time-to-diagnosis for imported Plasmodium falciparum malaria in children presenting to French pediatric emergency departments.
• To identify factors contributing to diagnostic delays and explore potential correlations with clinical parameters.

Main Methods:

• Prospective observational study conducted over one week in seven French pediatric emergency departments.
• Inclusion of 29 pediatric patients diagnosed with imported Plasmodium falciparum malaria.
• Analysis of patient delay, doctor delay, and total delay to diagnosis, alongside platelet counts.

Main Results:

• The mean total delay to diagnosis was 4.7 days (patient delay: 3.1 days, doctor delay: 1.5 days).
• Late diagnosis occurred in 11 patients, primarily due to physicians failing to consider malaria despite travel history, often misdiagnosing it as viral infection.
• Patients diagnosed promptly had significantly higher mean platelet counts (206,000/mm³) compared to those with delayed diagnosis (118,541/mm³).

Conclusions:

• Physician awareness regarding the risk of malaria in returning pediatric travelers is critical for reducing diagnostic delays.
• Early consideration of malaria, even with non-specific symptoms, and awareness of travel history can significantly shorten the time to diagnosis.
• Higher platelet counts may be associated with timely malaria diagnosis, warranting further investigation.