[Malaria following surgery in an endemic region]

The frequency of malaria attacks after surgery was determined during a 3-month period in the surgical ward of Bobo-Dioulasso hospital (Burkina Faso). The survey was carried out during the period of highest malarial morbidity. All adolescents and adults admitted to the ward were included, except women undergoing Cesarian section and patients who died in the perisurgical period. Patients were questioned as to the use of antimalarial drugs during the days prior to admission, their occupation and their place of residence. Malarial parasites were tested for routinely on D0, D2 and D5, and every day in case of suspected malaria. Malaria attacks were diagnosed on the basis of clinical signs (fever, headache and tiredness), and microscopic identification of parasites. Only 6% of the patients developed malaria attacks during the 5 days after surgery, and all were due to Plasmodium falciparum. Parasite density at the time of the attacks was between 1,000 and 10,000 PRBC/mm3. These patients did not differ from the overall population in social or medical characteristics. This low incidence of postsurgical malaria attacks relative to other African countries may be due to the routine use of antimalarial drugs in case of attacks. The frequency of such attacks appears to be overestimated by physicians, and microscopic analysis is thus recommended to establish the diagnosis after surgery.