Malaria in the returning older traveler

Area of Science:

• Infectious Diseases
• Geriatric Medicine
• Epidemiology

Background:

• Older adults face increased risks from imported illnesses due to comorbidities and physiological changes.
• Malaria is a common imported infection in travelers, with age independently linked to higher morbidity and mortality.
• Delayed diagnosis of malaria in elderly patients significantly increases the risk of poor clinical outcomes.

Purpose of the Study:

• To determine the proportion of malaria cases in patients aged 65 years and older.
• To compare hospital length of stay (LOS) between older and younger malaria patients.
• To describe comorbidities, diagnostic timelines, and factors contributing to delayed diagnosis and prolonged LOS in older malaria patients.

Main Methods:

• Retrospective cohort study of malaria patients aged 65+ from 2002-2012 in two university hospitals.
• Utilized a national inpatient database to identify all malaria cases and compare LOS across age groups (<65 and ≥65).
• Reviewed case notes for all patients in the older cohort.

Main Results:

• 12 out of 203 malaria cases (5.9%) were in patients aged 65 years or older.
• Median time to diagnosis for older patients was 2 days; median LOS was 8 days (vs. 3 days for <65).
• 11/12 older patients had ≥2 comorbidities; 6/12 were not diagnosed/treated within 48 hours of presentation.

Conclusions:

• Highlights the need for vigilant history-taking and timely malaria diagnosis in older travelers presenting with fever.
• Delayed diagnosis and treatment in elderly patients contribute to prolonged hospital stays and increased morbidity.
• Physicians must consider imported illnesses, especially malaria, in older patients with unexplained fever, given the rise in geriatric travel.