Journal Article

Imported Malaria: Prospective Analysis of Problems in Diagnosis and Management

Kevin C. Kain, Mary Anne Harrington, Shan Tennyson and Jay S. Keystone

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 1, pages 142-149
Published in print July 1998 | ISSN: 1058-4838
Published online July 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514616
Imported Malaria: Prospective Analysis of Problems in Diagnosis and Management

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Imported malaria is an increasing problem in many countries. The objective of this study was to prospectively evaluate the diagnosis and treatment of imported malaria cases identified by active surveillance. Microscopic diagnosis at the community level was also compared to reference microscopic and blinded molecular diagnostic methods. Most travelers who acquired malaria had sought pretravel advice from a physician; however, only 11% used recommended chemoprophylaxis and only 17% used insect protection measures. The diagnosis of malaria was initially missed in 59% of cases. Community-based microscopic diagnosis provided incorrect species identification in 64% of cases. After presentation, the average delay before treatment was 7.6 days for falciparum malaria and 5.1 days for vivax malaria. Overall, 7.5% of Plasmodium falciparum—infected patients developed severe malaria, and in 11% of all cases therapy failed. Patients who present to a center without expertise in tropical medicine receive suboptimal treatment. Improvements in recognition, diagnosis, and treatment of malaria are essential to prevent morbidity and death among travelers.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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