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[Malaria. Experience at a general hospital]
Abstract:
General hospitals should not ignore tropical diseases, even if they are not directly concerned with them. In our area, 3 and 6 instances of malaria have been diagnosed per year, 13 cases having been observed during the last 3 years. Prognosis is related with the quickness in achieving the diagnosis after the onset of symptoms; in our series it ranged from 4 days and one month. The outcome was good in all cases. To keep a reasonable good suspicion level, it should be remembered that the latency period between the infection and the development of symptoms may be very long. In 4 patients, the symptoms began 6 or more months after the patient had returned from the endemic zone. Chemoprophylaxis does not prevent the development of the disease in all individuals, although it is an effective prophylactic measure. Eight of these 13 patients had not undergone chemoprophylaxis or it had been incorrect. There was a remarkably high rate of patients infected by Pl. falciparum strains with in vivo resistance to antimalarial agents (chloroquine and fansidar).
Insights
General hospitals must recognize tropical diseases like malaria. Early diagnosis is key for good outcomes, even with long latency periods and drug-resistant malaria strains.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Public Health
Context:
- Malaria cases occur in non-endemic areas, necessitating awareness in general hospitals.
- The study observed 13 malaria cases over three years, with annual diagnoses of 3-6 instances.
- Delayed diagnosis, ranging from 4 days to one month, impacts patient prognosis.
Purpose:
- To highlight the importance of considering tropical diseases in general hospital settings.
- To analyze malaria case characteristics, diagnostic delays, and treatment outcomes.
- To emphasize the need for sustained vigilance regarding malaria, including drug resistance.
Summary:
- Prompt diagnosis is crucial for favorable malaria prognosis, with symptom onset varying significantly after return from endemic zones.
- Chemoprophylaxis is effective but not always followed or correctly administered, contributing to infection.
- A high prevalence of Plasmodium falciparum strains resistant to common antimalarials (chloroquine, fansidar) was noted.
Impact:
- General hospitals should maintain a high index of suspicion for tropical diseases, irrespective of their direct focus.
- Understanding long latency periods is vital for accurate diagnosis in returning travelers.
- Awareness of antimalarial drug resistance is essential for effective treatment strategies and patient management.