Clinical experience of 17 cases of imported malaria at a Taiwan university hospital, 1999-2005

Malaria had been eradicated in Taiwan since 1965, but there are currently 30 to 50 imported cases annually. The management of imported malaria continues to be challenging due to evolving drug resistance of Plasmodium parasites.

We retrospectively analyzed the clinical presentations, treatment, and outcomes of all 16 adult patients (17 episodes) with imported malaria diagnosed during 1999-2005. The clinical and laboratory features were obtained from the medical records.

Malaria was acquired in sub-Saharan Africa in 6 cases and Southeast Asia in 11 cases. The initial presentations were nonspecific, including fever (17/17 cases), headache (11/17), nausea, vomiting or diarrhea (10/17), cough (3/17), thrombocytopenia (15/17), mild hyperbilirubinemia (13/17), leukopenia (6/17) and anemia (4/17). Careful travel history led to the correct diagnosis in 16 of 17 cases. All 17 cases survived without any recrudescence. Four cases presented with hyperparasitaemia (>5%). Two patients were admitted to an intensive care unit for complicated malaria, and both were cured by artesunate plus mefloquine. Some suboptimal practices, such as non-standard therapeutic regimen and lack of daily parasitemia counting were noted.

A differential diagnosis of malaria should be made in all patients who have fever after travel to any endemic area. To further improve the management of imported malaria, timely consultation of an experienced infectious disease specialist is necessary.