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Imported pediatric malaria presenting to an urban pediatric emergency department: a case series
Kevin R Schwartz1, Robert Vinci
1Division of Pediatric Emergency Medicine, Boston Medical Center, Boston, MA 02118, USA. Kevin.Schwartz@bmc.org
Insights
Pediatric malaria symptoms are often nonspecific and inconsistently present in US emergency departments. Maintaining a high index of suspicion is crucial for diagnosing imported malaria in children returning from endemic areas.
Area of Science:
- Tropical medicine
- Pediatric infectious diseases
- Emergency medicine
Background:
- Imported pediatric malaria presents a diagnostic challenge in non-endemic regions.
- Early identification and treatment are crucial to prevent severe outcomes.
Observation:
- A retrospective review of 21 pediatric patients diagnosed with malaria in a US urban emergency department (ED) between 2004 and 2011.
- The majority (71%) were infected with Plasmodium falciparum.
- Patients presented with nonspecific symptoms, often with a delay after returning from malaria-endemic areas.
Findings:
- Fever was reported by all patients, but documented in only 43% of ED visits.
- Common symptoms included headache (66%), anorexia (62%), chills (52%), and abdominal pain (48%).
- Tachycardia (86%) was the most common sign, and thrombocytopenia (76%) was the most frequent laboratory abnormality.
Implications:
- The nonspecific nature of symptoms necessitates a high index of suspicion for malaria in febrile children returning from endemic regions.
- Prompt recognition and diagnosis are vital for effective management and improved patient outcomes.
- This study highlights the importance of considering travel history in the differential diagnosis of febrile pediatric patients.
Objective:
The objective of this study was to identify common presenting signs, symptoms, and laboratory findings of imported pediatric malaria presenting to a US pediatric emergency department (ED).
Methods:
This is a retrospective chart review of all patients presenting to an urban pediatric ED between July 1, 2004, and July 1, 2011, who were assigned an ED or inpatient discharge diagnosis of "malaria" and had a confirmed blood smear demonstrating plasmodium species.
Results:
There were 21 patients included in this study (median age, 12 years; range, 19 months to 22 years). A total of 15 (71%) were infected with Plasmodium falciparum subtype of malaria. Patients presented to the ED between 1 day and 2 years after return from a malaria-endemic area. All 21 patients (100%) reported a history of fever, but only 9 (43%) had a fever documented in the ED. Of the patients, 14 (66%) complained of headache, 13 (62%) complained of anorexia, 11 (52%) complained of chills, and 10 (48%) complained of abdominal pain. The most common sign was tachycardia, present in 18 patients (86%). Consistent with other studies, thrombocytopenia was the most frequently observed laboratory abnormality, present in 16 patients (76%).
Conclusions:
The presenting signs and symptoms of imported pediatric malaria are nonspecific and inconsistently present, underscoring the importance of maintaining a high index of suspicion for this diagnosis in any patient returning from a malaria-endemic region.
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