Malaria: 11-Year Experience With Imported Cases at a German University Hospital and Epidemiological Trends Amid the
Patricia Mester1, Claudia Kunst1, Stephan Schmid1
1Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany, uniklinikum-regensburg.de.
Background:
By the mid-20th century, Europe eradicated endemic malaria. However, the significance of imported infections in nonendemic regions is growing. These cases often constitute the majority, can sustain transmission, trigger relapses, and increase mortality in these areas.
Methods:
We conducted a retrospective, single-center study of patients with malaria treated at the University Hospital Regensburg located in the State of Bavaria, Germany, between 2012 and 2023. Our single-center epidemiological data were analyzed in the context of the COVID-19 pandemic and compared with overall data from Bavaria, Germany, and Europe.
Results:
Fifty-eight patients with malaria were treated at a German university hospital. The median age at diagnosis was 37.5 years, with 65% of patients being male. A total of 31.6% of the patients required intensive care. This study revealed a survival rate of 98%. Only 17% had taken malaria prophylaxis, and Plasmodium falciparum was the causative agent in 96% of cases. The primary laboratory abnormality was thrombocytopenia. Germany reports a significant number of imported malaria cases annually. North Rhine-Westphalia is the most affected region. The COVID-19 pandemic impacted global malaria epidemiology, leading to a drastic decrease in malaria cases across Europe, including Germany.
Conclusion:
Imported malaria remains rare in Europe. However, severe cases still occur, often requiring intensive care and resulting in high morbidity or even death. The diagnosis and management of malaria in nonendemic settings present a clinical challenge, and the delayed diagnosis is responsible for preventable deaths.
Insights
Imported malaria cases in Germany are increasing, with Plasmodium falciparum being the most common cause. Despite a high survival rate, delayed diagnosis in non-endemic areas poses significant risks.
Area of Science:
- Tropical medicine
- Infectious diseases
- Epidemiology
Background:
- Malaria was eradicated in mid-20th century Europe, but imported cases are rising.
- Imported malaria can sustain transmission, trigger relapses, and increase mortality in non-endemic regions.
- Understanding imported malaria trends is crucial for public health in Europe.
Purpose of the Study:
- To analyze the epidemiological characteristics of malaria cases treated at a German university hospital.
- To assess the impact of the COVID-19 pandemic on imported malaria cases.
- To compare local data with national and European malaria statistics.
Main Methods:
- Retrospective, single-center study of malaria patients at University Hospital Regensburg (2012-2023).
- Analysis of epidemiological data in the context of the COVID-19 pandemic.
- Comparison with aggregated data from Bavaria, Germany, and Europe.
Main Results:
- 58 malaria patients treated; median age 37.5 years, 65% male.
- 96% of cases caused by Plasmodium falciparum; 31.6% required intensive care.
- 98% survival rate; only 17% used malaria prophylaxis; thrombocytopenia was common.
- COVID-19 pandemic led to a decrease in malaria cases across Europe.
Conclusions:
- Imported malaria, though rare in Europe, can cause severe illness and death.
- Delayed diagnosis in non-endemic settings is a significant challenge and leads to preventable mortality.
- Effective diagnosis and management are critical for improving outcomes of imported malaria.
Related Concept Videos
00:58Symbiosis
01:28Infectious Diseases and Their Occurrence