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Review of 40 children with imported malaria
1Department of Paediatrics, Faculty of Medicine, University of Toronto, Ontario, Canada.
Abstract:
Forty cases of imported malaria (1978 to 1988) are reviewed and management principles are discussed. All 15 cases of Plasmodium falciparum malaria were acquired in Africa, 5 of which were probably chloroquine-resistant. Most cases of Plasmodium vivax (80%) were acquired on the Indian subcontinent, including 2 cases of congenital malaria. Six children developed P. falciparum malaria despite chemoprophylaxis. All children had a history of fever, usually with other influenza-like symptoms. Two-thirds had splenomegaly, and one-third were afebrile on admission. Thrombocytopenia (70%) and anemia (70%) were often present. Forty-five percent received previous wrong diagnoses and treatments. Quinine or quinidine with either Fansidar or clindamycin were used to treat P. falciparum malaria. Clindamycin may be more effective if given for 7 instead of 3 days. There were no deaths or residual complications. As the prevalence and severity of drug-resistant P. falciparum spreads, prophylaxis and treatment choices become more difficult. Diagnosis requires a travel history and a high index of suspicion.
Insights
Imported malaria cases, including drug-resistant Plasmodium falciparum, highlight diagnostic challenges. Prompt diagnosis and appropriate treatment are crucial for preventing severe outcomes in travelers.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Public Health
Background:
- Imported malaria remains a concern in non-endemic regions.
- Drug resistance, particularly in Plasmodium falciparum, complicates treatment strategies.
- Accurate diagnosis and management are vital for patient outcomes.
Purpose of the Study:
- To review cases of imported malaria and discuss management principles.
- To analyze the characteristics and outcomes of malaria in imported cases.
- To highlight challenges in prophylaxis and treatment due to drug resistance.
Main Methods:
- Retrospective review of 40 imported malaria cases diagnosed between 1978 and 1988.
- Analysis of patient demographics, travel history, clinical presentation, and treatment regimens.
- Evaluation of diagnostic accuracy and treatment efficacy.
Main Results:
- Plasmodium falciparum malaria cases were primarily acquired in Africa, with some likely chloroquine-resistant.
- Plasmodium vivax malaria cases were mostly from the Indian subcontinent, including congenital cases.
- Children with P. falciparum malaria often presented with fever, influenza-like symptoms, thrombocytopenia, and anemia, despite chemoprophylaxis.
- A significant percentage received incorrect initial diagnoses and treatments.
- Treatment with quinine or quinidine, with Fansidar or clindamycin, was used for P. falciparum malaria.
Conclusions:
- Imported malaria requires a high index of suspicion and thorough travel history for diagnosis.
- Increasing drug resistance in Plasmodium falciparum necessitates careful consideration of prophylaxis and treatment options.
- Prompt and accurate management of imported malaria can prevent severe complications and fatalities.