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Oceane Minka S, Cottrell G, Cot M, Hillary Minka F, Thellier M, Choquet C, Houze S. New guidelines reduce the risk of hospitalization for adult patients with uncomplicated Plasmodium falciparum malaria: An observational, multicenter, retrospective French study. Infect Dis Now 2024:104963. [PMID: 39173714 DOI: 10.1016/j.idnow.2024.104963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 08/05/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES We aimed to evaluate the impact of malaria declaration year (before or after 2017) on the frequency of hospitalization in metropolitan France of patients with uncomplicated non-vomiting P.falciparum malaria. PATIENTS AND METHODS An observational, multicenter, retrospective study was carried out, using the database from the French National Reference Centre for Malaria. Descriptive analysis and multivariate analysis by logistic regression were performed using the multiple imputation by chained equation method to handle missing data. RESULTS More than 2000 (2184) uncomplicated non-vomiting P.falciparum malaria cases were recorded. Our multivariate analysis showed an association between the year 2018 and reduced risk of hospitalization (OR: 0.89; 95% CI: 0.81-0.97). CONCLUSION Compared to 2016, during 2018 we observed a trend toward ambulatory care for patients presenting with uncomplicated non-vomiting P.falciparum malaria.
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Affiliation(s)
- Sally Oceane Minka
- Centre Hospitalier Universitaire de Bichat, Service des Urgences, 75018 Paris, France; Université Paris Cité, 75006 Paris, France.
| | | | - Michel Cot
- Faculté de pharmacie, IRD, UMR-MERIT, 75006 Paris, France
| | - Fadi Hillary Minka
- Centre Hospitalier Universitaire de Lariboisière, Service des Urgences, 75010 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Marc Thellier
- Centre Hospitalier Universitaire de la Pitié Salpétrière, CNR du Paludisme, 75013 Paris, France; Université Sorbonne Paris Nord, 75013 Paris, France
| | - Christophe Choquet
- Centre Hospitalier Universitaire de Bichat, Service des Urgences, 75018 Paris, France
| | - Sandrine Houze
- Faculté de pharmacie, IRD, UMR-MERIT, 75006 Paris, France; Centre Hospitalier Universitaire de Bichat, CNR du Paludisme, 75018 Paris, France
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Jia L, Chen X, Feng Z, Tang S, Feng D. Factors affecting delays in seeking treatment among malaria patients during the pre-certification phase in China. Malar J 2024; 23:73. [PMID: 38468296 DOI: 10.1186/s12936-024-04892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Delays in malaria treatment can not only lead to severe and even life-threatening complications, but also foster transmission, putting more people at risk of infection. This study aimed to investigate the factors influencing treatment delays among malaria patients and their health-seeking behaviour. METHODS The medical records of 494 patients diagnosed with malaria from 6 different malaria-endemic provinces in China were analysed. A bivariate and multivariable regression model was used to investigate the association between delays in seeking treatment and various factors. A Sankey diagram was used to visualize the trajectories of malaria patients seeking medical care. Total treatment delays were categorized as patient delays and doctor delays. RESULTS The incidence of total delays in seeking malaria treatment was 81.6%, of which 28.4% were delayed by patients alone and 34.8% by doctors alone. The median time from the onset of symptoms to the initial healthcare consultation was 1 day. The median time from the initial healthcare consultation to the conclusive diagnosis was 2 day. After being subjected to multiple logistic regression analysis, living in central China was less likely to experience patient delays (OR = 0.43, 95% CI 0.24-0.78). The factors significantly associated with the lower likelihood of doctor delays included: age between 30 to 49 (OR = 0.43, 95% CI 0.23-0.81), being single/divorce/separated (OR = 0.48, 95% CI 0.24-0.95), first visiting a county-level health institution (OR = 0.25, 95% CI 0.14-0.45), first visiting a prefectural health institution (OR = 0.06, 95% CI 0.03-0.12) and first visiting a provincial health institution (OR = 0.05, 95%CI 0.02-0.12). Conversely, individuals with mixed infections (OR = 2.04, 95% CI 1.02-4.08) and those experiencing periodic symptoms (OR = 1.71, 95% CI 1.00-2.92) might face increased doctor delays. Furthermore, higher financial burden and complications were found to be associated with patient delays. Doctor delays, in addition to incurring these two consequences, were associated with longer hospital stays. CONCLUSION There was a substantial delay in access to health care for malaria patients before China was certified malaria free. Region, marital status, periodic symptoms and the level of health institutions were factors contributing to delays in treatment-seeking among malaria patients.
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Affiliation(s)
- Lianyu Jia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xiaoyu Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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3
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Gallet S, Dard C, Bailly S, Thellier M, Houze S, Pelloux H, Epaulard O. Length of stay in at-risk areas and time to malaria attack on return. Infect Dis Now 2024; 54:104819. [PMID: 37890619 DOI: 10.1016/j.idnow.2023.104819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Experimental infection with Plasmodium falciparum results in malaria attack within a few days of exposure. However, we have regularly observed malaria attack within a short time after return, regardless of the time spent in an endemic area. We therefore aimed to assess whether the time before return and malaria attack varies according to length of stay. METHODS We used anonymized data from the French National Reference Centre for Malaria between 2006 and 2016. We analyzed 11,823 cases aged at least 1 year and diagnosed with P. falciparum malaria 1 day to 1 year after returning to France, after a stay of 1 day to 1 year in an at-risk area. RESULTS Trips had a median duration of 31 days [IQR: 19-56]. Median time between return from the endemic area and onset of malaria symptoms was 5 days [IQR: 0-10], and the median between return and malaria diagnosis was 9 days [IQR: 5-14]. Times to symptom onset or diagnosis were longer for stays of fewer than 15 days vs 15 days or more (for symptoms: 7 vs 4 days for longer stays, for diagnosis: 11 vs 9 days). For stays longer than 15 days, no variation was observed according to length of stay. CONCLUSIONS Aside from at-risk stays of fewer than 15 days, the time between return and malaria attack is constant and rather short, even after long stays. The 2 weeks following return should be considered as a risk period whatever the length of stay in an at-risk area.
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Affiliation(s)
- Salomé Gallet
- Clinical Infectious Disease Unit, Grenoble-Alpes University Hospital, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC 1406 - Inserm - Université Grenoble Alpes, Grenoble, France.
| | - Céline Dard
- Parasitology-Mycology Laboratory, Grenoble-Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
| | - Marc Thellier
- Parasitology-Mycology Laboratory, Pitié Salpêtrière Hospital, APHP, Paris, France; Centre National de Référence du Paludisme, AP-HP, Paris, France
| | - Sandrine Houze
- Parasitology-Mycology Laboratory, APHP, Hôpital Bichat, Paris, France; Centre National de Référence du Paludisme, AP-HP, Paris, France
| | - Hervé Pelloux
- Parasitology-Mycology Laboratory, Grenoble-Alpes University Hospital, Grenoble, France
| | - Olivier Epaulard
- Clinical Infectious Disease Unit, Grenoble-Alpes University Hospital, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC 1406 - Inserm - Université Grenoble Alpes, Grenoble, France
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4
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Bosilkovski M, Khezzani B, Poposki K, Semenakova-Cvetkovska V, Vidinic I, Lloga AO, Jakimovski D, Dimzova M. Epidemiological and clinical characteristics of imported falciparum malaria in the Republic of North Macedonia : A 13-year experience. Wien Klin Wochenschr 2023; 135:609-616. [PMID: 37010597 DOI: 10.1007/s00508-023-02192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/05/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Plasmodium falciparum is the leading cause of imported malaria and the most common cause of death in returning travellers. AIM To identify the main epidemiological and clinical characteristics of patients with imported falciparum malaria in the Republic of North Macedonia. MATERIAL AND METHODS Retrospectively analyzed were the epidemiological and clinical features of 34 patients with imported falciparum malaria who were diagnosed and treated at the university clinic for infectious diseases and febrile conditions in Skopje from 2010 to 2022. Malaria diagnosis was based on the microscopic detection of parasites in thick and thin blood smears. RESULTS All patients were male, with a median age of 36 years and a range of 22-60 years. Of the patients 33 (97.1%) acquired the disease in Sub-Saharan Africa. All patients except one stayed in endemic regions for work/business purposes. Chemoprophylaxis was completely applied in 4 (11.8%) patients. The median time of onset between the symptoms and diagnosis was 4 days, with a range of 1-12 days. Prevailing clinical manifestations were fever, chills, and splenomegaly in 100%, 94%, and 68% of patients, respectively. Severe malaria was noticed in 8 (23.5%) patients. In 5 (14.7%) patients the initial parasitemia was higher than 5%. On admission, thrombocytopenia, hyperbilirubinemia, and elevated alanine aminotransferase were registered in 94%, 58%, and 62% of patients, respectively. Out of the 33 patients with adequate follow-up, the outcome was favorable in 31 (93.9%). CONCLUSION In every febrile traveller returned from Africa, imported falciparum malaria should be an essential part of differential diagnostic considerations.
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Affiliation(s)
- Mile Bosilkovski
- University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia
| | - Bachir Khezzani
- Department of Biology, Faculty of Natural and Life Sciences, University of El Oued, PO Box 789, 39000, El Oued, Algeria.
- Laboratory of Biology, Environment and Health (LBEH), Faculty of Natural and Life Sciences, University of El Oued, PO Box 789, 39000, El Oued, Algeria.
| | - Kostadin Poposki
- University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia
| | - Vesna Semenakova-Cvetkovska
- University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia
| | - Ivan Vidinic
- University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia
| | - Arlinda Osmani Lloga
- University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia
| | - Dejan Jakimovski
- University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia
| | - Marija Dimzova
- University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia
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5
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Flateau C, Pitsch A, Cornaglia C, Picque M, de Pontfarcy A, Leroy P, Jault T, Thach C, Camus M, Dolveck F, Diamantis S. Management of imported malaria in the emergency department: Adequacy compared to guidelines, and impact of the SARS-CoV-2 pandemic. Infect Dis Now 2023; 53:104672. [PMID: 36773811 PMCID: PMC9912039 DOI: 10.1016/j.idnow.2023.104672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/13/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES Adequacy of imported malaria management with respect to guidelines in emergency departments (ED) is low. We aimed to identify factors associated with this non-compliance, and a potential impact of the SARS-CoV-2 pandemic. PATIENTS AND METHODS Patients presenting with imported malaria at the ED of the hospital of Melun (France), from January 1, 2017 to February 14, 2022 were retrospectively included. RESULTS Among 205 adults and 25 children, biological criteria of severity were fully assessed in 10% of cases; lactates (40%) and blood pH (21%) levels were the main missing variables. Of 74 patients (32%) with severe malaria, 13 were misclassified as uncomplicated malaria. The choice and dosage of treatment were adequate in 85% and 92% of cases, respectively. Treatment conformity was lower in severe malaria cases than in non-severe malaria cases (OR 0.15 [95% CI 0.07-0.31]), with oral treatment in 17 patients with severe malaria; conformity was higher in the intensive care unit (OR 4.10 [95% CI 1.21-13.95]). Patients with severe malaria were more likely to start treatment within 6hours than patients with uncomplicated malaria (OR 1.97 [95% CI 1.08-3.43]), as were patients infected by P.falciparum compared to other species (OR 4.63 [95% CI 1.03-20.90]). Consulting during the SARS-CoV-2 pandemic was the only organizational factor associated with a lower probability of adequate management (OR 0.42 [95% CI 0.23-0.75]). CONCLUSION Initial evaluation of malaria severity and time to treatment administration could be improved. These have been adversely impacted by the SARS-CoV-2 pandemic.
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Affiliation(s)
- C. Flateau
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France,Corresponding author at: Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France. Fax: + 33 1 81 74 18 12
| | - A. Pitsch
- Laboratoire de biologie médicale, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - C. Cornaglia
- Service d’accueil des urgences, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - M. Picque
- Laboratoire de biologie médicale, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - A. de Pontfarcy
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - P. Leroy
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - T. Jault
- Service de gynécologie-obstétrique, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - C. Thach
- Service de pédiatrie, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - M. Camus
- Pharmacie hospitalière, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - F. Dolveck
- Service d’accueil des urgences, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
| | - S. Diamantis
- Service des maladies infectieuses, Groupe hospitalier Sud Ile de France, 270 avenue Marc Jacquet, 77 000 Melun, France
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6
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Bonsergent M, Tching-Sin M, Honoré S, Bertault-Peres P, Lepelletier A, Flet L, Perez T. Use of artesunate in the treatment of severe imported malaria in France: review of the effectiveness and real-life safety in two French university hospitals. BMC Infect Dis 2023; 23:359. [PMID: 37231336 DOI: 10.1186/s12879-023-08260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Intravenous artesunate (AS) is the first-line treatment for patients with severe imported malaria (SIM) worldwide. However, after 10 years of use in France, AS hasn't yet received marketing authorization.The purpose of this study was to assess the real-life effectiveness and safety of AS in the treatment of SIM in two Hospitals in France. METHODS We performed a bicenter retrospective and observational study. All patients treated with AS for SIM between 2014 and 2018 and 2016-2020 were included. The effectiveness of AS was evaluated by parasite clearance, number of deaths, and the length of hospital stay. The real-life safety was assessed by related adverse events (AE) and monitoring of biological blood parameters during the hospital stay and follow-up period. RESULTS 110 patients were included during the six-year study period. 71.8% of patients were parasite-negative of their day 3 thick and thin blood smears after AS treatment. No patients discontinued AS due to an AE and no serious AE were declared. Two cases of delayed post-artesunate hemolysis occurred and required blood transfusions. CONCLUSION This study highlights effectiveness and safety of AS in non-endemic areas. Administrative procedures must be accelerated in order to obtain full registration and facilitate access to AS in France.
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Affiliation(s)
- M Bonsergent
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France.
| | - M Tching-Sin
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - S Honoré
- Assistance Publique des Hôpitaux de Marseille, CHU Marseille, Pharmacie, Marseille, France
| | - P Bertault-Peres
- Assistance Publique des Hôpitaux de Marseille, CHU Marseille, Pharmacie, Marseille, France
| | - A Lepelletier
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - L Flet
- Nantes Université, CHU Nantes, Pharmacie, Nantes, F-44000, France
| | - T Perez
- Assistance Publique des Hôpitaux de Marseille, CHU Marseille, Pharmacie, Marseille, France
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7
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Zhang T, Wang D, Qian Y, Ruan W, Liu Y, Xia J, Yan H, Sui Y, Lu S, Xu X, Jiang J, Lyu X, Wang S, Li S, Li W. Profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria: a retrospective study in China, 2014-2021. Infect Dis Poverty 2022; 11:125. [PMID: 36550586 PMCID: PMC9773583 DOI: 10.1186/s40249-022-01050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In areas where malaria has been eliminated, delayed care-seeking and diagnosis of imported malaria are constant threats. This study aimed to describe the profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria in China. METHODS This retrospective study assessed surveillance data obtained from 2014 to 2021 in the Chinese provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, and Zhejiang, and Guangxi. Epidemiological characteristics were analyzed using descriptive statistics. Furthermore, factors associated with delayed care-seeking and diagnosis among imported malaria cases were identified using multivariate logistic regression. RESULTS Overall, 11.81% and 30.08% of imported malaria cases had delays in seeking care and diagnosis, respectively. During the study period, there was a decreasing trend in the proportion of imported malaria cases with delayed care-seeking (χ2 = 36.099, P < 0.001) and diagnosis (χ2 = 11.395, P = 0.001). In multivariate analysis, independent risk factors associated with delayed care-seeking include PLADs (Guangxi as reference), consultations in high-level facilities for the first medical visit, infections with non-Plasmodium falciparum species, and older age. However, PLADs (Guangxi as reference), the purpose of traveling (labour as reference), and infections with non-P. falciparum species increased the risk of delayed diagnosis. Delayed care-seeking (adjusted odds ratio: 1.79, P = 0.001) and diagnosis (adjusted odds ratio: 1.62, P = 0.004) were risk factors for severe disease development. CONCLUSIONS Based on this study's findings, we strongly advocate for improved access to quality healthcare to reduce the rate of misdiagnosis at the first visit. Infections caused by non-P. falciparum species should be highlighted, and more sensitive and specific point-of-care detection methods for non-P. falciparum species should be developed and implemented. In addition, education programs should be enhanced to reach target populations at risk of malaria infection. All these factors may reduce delayed care-seeking and diagnosis of imported malaria.
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Affiliation(s)
- Tao Zhang
- grid.410620.10000 0004 1757 8298Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601 China
| | - Duoquan Wang
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025 China ,grid.16821.3c0000 0004 0368 8293School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Yingjun Qian
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025 China
| | - Wei Ruan
- grid.433871.aZhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051 China
| | - Ying Liu
- grid.418504.cHenan Provincial Center for Disease Control and Prevention, Zhengzhou, 450016 China
| | - Jing Xia
- grid.508373.a0000 0004 6055 4363Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079 China
| | - Hui Yan
- grid.418332.fGuangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, 530028 China
| | - Yuan Sui
- grid.4367.60000 0001 2355 7002Brown School, Washington University, St. Louis, MO USA
| | - Shenning Lu
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025 China
| | - Xian Xu
- grid.410620.10000 0004 1757 8298Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601 China
| | - Jingjing Jiang
- grid.410620.10000 0004 1757 8298Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601 China
| | - Xiaofeng Lyu
- grid.410620.10000 0004 1757 8298Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601 China
| | - Shuqi Wang
- grid.410620.10000 0004 1757 8298Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601 China
| | - Shizhu Li
- grid.508378.1National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025 China ,grid.16821.3c0000 0004 0368 8293School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China
| | - Weidong Li
- grid.410620.10000 0004 1757 8298Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601 China
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8
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Trojánek M, Grebenyuk V, Richterová L, Zicklerová I, Nohýnková E, Manďáková Z, Kantor J, Roháčová H, Stejskal F. Epidemiology and clinical features of imported malaria: a 14-year retrospective single-centre descriptive study in Prague, Czech Republic. Malar J 2022; 21:257. [PMID: 36068598 PMCID: PMC9447980 DOI: 10.1186/s12936-022-04282-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Malaria represents one of the most important imported tropical infectious diseases in European travellers. The objective of the study was to identify changes in the epidemiological features of imported malaria and to analyse the clinical findings and outcomes of imported malaria. Methods This single-centre descriptive study retrospectively analysed the medical records of all imported malaria cases in travellers treated at the Department of Infectious Diseases of University Hospital Bulovka in Prague from 2006 to 2019. Results The study included 203 patients with a median age of 37 years (IQR 30–48) and a male to female ratio of 3.72:1. Plasmodium falciparum was the predominant species (149/203), and its proportion significantly increased from 35/60 cases (58.3%) in 2006–2011 to 69/80 (86.3%) in 2016–2019 (p < 0.001). In contrast, the incidence of Plasmodium vivax malaria decreased from 19/60 cases (31.7%) in 2006–2011 to 5/80 (6.3%) in 2016–2019 (p < 0.001). Malaria was imported from sub-Saharan Africa in 161/203 cases (79.3%). The proportion of travellers from Southeast and South Asia decreased from 16/60 (26.7%) and 6/60 (10.0%) in 2006–2011 to 2/80 (2.5%) and no cases (0.0%) in 2016–2019, respectively (p < 0.001 and p = 0.006). Tourism was the most common reason for travel (82/203), however, the proportion of non-tourists significantly increased over time from 29/60 (48.3%) in 2006–2011 to 55/80 (68.8%) in 2016–2019, p = 0.015. Severe malaria developed in 32/203 (15.8%) patients who were significantly older (p = 0.013) and whose treatment was delayed (p < 0.001). Two lethal outcomes were observed during the study period. Conclusions This study demonstrated a significant increase in P. falciparum malaria, which frequently resulted in severe disease, especially in older patients and those with delayed treatment initiation. The rising proportion of imported malaria in non-tourists, including business travellers and those visiting friends and relatives, is another characteristic finding analogous to the trends observed in Western European and North American centres. The described changes in the aetiology and epidemiology of imported malaria may serve to optimize pre-travel consultation practices and improve post-travel diagnostics and medical care. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04282-8.
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Affiliation(s)
- Milan Trojánek
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, Institute for Postgraduate Medical Education, Prague, Czech Republic
| | - Vyacheslav Grebenyuk
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic. .,Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.
| | - Lenka Richterová
- Department of Clinical Microbiology, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious and Tropical Diseases, 1st Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic.,Department of Microbiology of the 3rd Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, National Institute of Public Health, Šrobárova 50, 100 34, Prague, Czech Republic
| | - Ivana Zicklerová
- Department of Clinical Microbiology, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic
| | - Eva Nohýnková
- National Reference Laboratory for the Diagnosis of Tropical Parasitic Infections, Budínova 2, 180 81, Prague, Czech Republic.,Institute of Immunology and Microbiology, 1st Faculty of Medicine, Charles University, Studničkova 7, 128 00, Prague, Czech Republic
| | - Zdenka Manďáková
- Department of Epidemiology of Infectious Diseases, National Institute of Public Health, Šrobárova, Prague, Czech Republic
| | - Jakub Kantor
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic
| | - Hana Roháčová
- Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic
| | - František Stejskal
- Department of Infectious Diseases, 2nd Faculty of Medicine, Charles University, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, University Hospital Bulovka, Budínova 2, 180 81, Prague, Czech Republic.,Department of Infectious Diseases, Regional Hospital Liberec, Husova 10, 460 63, Liberec, Czech Republic
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9
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Mahittikorn A, Mala W, Wilairatana P, Siri S, Masangkay FR, Kotepui KU, Kotepui M. Prevalence, anti-malarial chemoprophylaxis and causes of deaths for severe imported malaria: A systematic review and meta-analysis. Travel Med Infect Dis 2022; 49:102408. [PMID: 35985533 DOI: 10.1016/j.tmaid.2022.102408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are limited data regarding prevalence, anti-malarial chemoprophylaxis, and causes of death for severe imported malaria. Thus, we conducted a systematic review and meta-analysis to characterise these variables. METHODS We searched studies reporting deaths attributable to severe imported malaria. The following pooled prevalence rates were determined: 1) the pooled prevalence of severe malaria among patients with imported malaria, 2) the pooled prevalence of deaths among patients with severe imported malaria, 3) the pooled prevalence of anti-malarial chemoprophylaxis among patients with severe imported malaria, and 4) the causes of death among patients with severe imported malaria. RESULTS The search identified 52 studies that were mainly conducted in Europe (25, 48.1%), North America (16, 30.8%) and Asia (7, 13.5%). The pooled prevalence of severe imported malaria was 12.5% (95% confidence interval [CI] = 10.3%-14.6%, I2 = 99.32%, 12393 severe cases/118325 imported cases). The pooled prevalence of deaths attributable to severe imported malaria was 5.1% (95% CI = 4.0%-6.2%, I2 = 91.72%, 721 deaths/16310 severe cases). The pooled prevalence of adequate anti-malarial chemoprophylaxis among patients with severe imported malaria was 9.7% (95% CI = 6.5%-13.0%, I2 = 89.9%, 203/2049 cases). The most common cause of death was multi-organ failure (12.3%). CONCLUSION The results highlighted the need for education and preventative measures for travellers, immigrants, or workers who plan to visit malaria-endemic areas to minimize the risk of severe disease or death.
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Affiliation(s)
- Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Wanida Mala
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Sukhontha Siri
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | | | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
| | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Tha Sala, Nakhon Si Thammarat, Thailand.
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10
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Pistarà E, Marino A, Ceccarelli M, Cosentino F, Moscatt V, Gussio M, Micali C, Nunnari G, Cacopardo B, Celesia BM. HIV Infection Diagnosis in a Late Presenter Patient during a Severe Imported Falciparum Malaria: A Challenging. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND: Malaria and HIV share the same epidemiological spreading and coinfection may be clinically challenging. In 2019, nearly all malaria cases reported by EU/EEA countries were imported. Severe falciparum malaria is a medical emergency often associated with poor outcome, even when treated with appropriate therapy.
CASE PRESENTATION: Here, we described an unusual case of a late presenter HIV diagnosis made during the management of a severe falciparum malaria in an Italian traveler returning from Nigeria, who did not take antimalaria prophylaxis. Clinical course was complicated by the occurrence of several superinfections caused by deep immunosuppression, and bilateral subsegmental pulmonary embolism.
CONCLUSION: Although critical conditions, malaria prompt diagnosis and treatment, along with HIV diagnosis and the successful treatment of occurred superinfection, resulted in a positive outcome.
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11
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Kumar V, Ray S, Aggarwal S, Biswas D, Jadhav M, Yadav R, Sabnis SV, Banerjee S, Talukdar A, Kochar SK, Shetty S, Sehgal K, Patankar S, Srivastava S. Multiplexed quantitative proteomics provides mechanistic cues for malaria severity and complexity. Commun Biol 2020; 3:683. [PMID: 33204009 PMCID: PMC7672109 DOI: 10.1038/s42003-020-01384-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
Management of severe malaria remains a critical global challenge. In this study, using a multiplexed quantitative proteomics pipeline we systematically investigated the plasma proteome alterations in non-severe and severe malaria patients. We identified a few parasite proteins in severe malaria patients, which could be promising from a diagnostic perspective. Further, from host proteome analysis we observed substantial modulations in many crucial physiological pathways, including lipid metabolism, cytokine signaling, complement, and coagulation cascades in severe malaria. We propose that severe manifestations of malaria are possibly underpinned by modulations of the host physiology and defense machinery, which is evidently reflected in the plasma proteome alterations. Importantly, we identified multiple blood markers that can effectively define different complications of severe falciparum malaria, including cerebral syndromes and severe anemia. The ability of our identified blood markers to distinguish different severe complications of malaria may aid in developing new clinical tests for monitoring malaria severity.
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Affiliation(s)
- Vipin Kumar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Sandipan Ray
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shalini Aggarwal
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Deeptarup Biswas
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Manali Jadhav
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Radha Yadav
- Department of Mathematics, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Sanjeev V Sabnis
- Department of Mathematics, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Soumaditya Banerjee
- Medicine Department, Medical College Hospital Kolkata, 88, College Street, Kolkata, 700073, India
| | - Arunansu Talukdar
- Medicine Department, Medical College Hospital Kolkata, 88, College Street, Kolkata, 700073, India
| | - Sanjay K Kochar
- Department of Medicine, Malaria Research Centre, S.P. Medical College, Bikaner, 334003, India
| | - Suvin Shetty
- Dr. L H Hiranandani Hospital, Mumbai, 400076, India
| | | | - Swati Patankar
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India
| | - Sanjeeva Srivastava
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, 400076, India.
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12
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Xia J, Wu D, Wu K, Zhu H, Sun L, Lin W, Li K, Zhang J, Wan L, Zhang H, Liu S. Epidemiology of Plasmodium falciparum Malaria and Risk Factors for Severe Disease in Hubei Province, China. Am J Trop Med Hyg 2020; 103:1534-1539. [PMID: 32700677 DOI: 10.4269/ajtmh.20-0299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study aimed to describe the epidemiology of Plasmodium falciparum malaria and identify risk factors for severe disease in Hubei Province, China, using a case-based survey of retrospective data from 2013 to 2018. From 2013 to 2018, a total of 763 imported malaria cases were reported in Hubei Province; 69.2% (528/763) cases were caused by P. falciparum species. The proportion of malaria caused by P. falciparum increased from 66.7% in 2013 to 74.0% in 2018 (χ2 = 21.378, P < 0.05). Plasmodium falciparum malaria was reported in 77 counties of Hubei Province. The majority of imported P. falciparum cases originated from Africa (98.9%, 522/528); 9.7% (51/528) of patients infected with P. falciparum developed severe malaria. Three deaths (case fatality rate: 0.6%) were related to imported P. falciparum malaria. Risk factors for severe malaria were being female (odds ratio [OR] = 3.593, 95% CI: 1.003-12.874), age ≥ 50 years (OR = 2.674, 95% CI: 1.269-5.634), > 3 days between symptom onset and diagnosis (OR = 2.383, 95% CI: 1.210-4.693), and the first-visit medical institution at the township level or lower (OR = 2.568, 95% CI: 1.344-4.908). Malaria prevention should be undertaken among high-risk groups, infection with P. falciparum should be detected early to prevent severe disease and death, and healthcare providers in health facilities at the township level should be trained on early recognition of malaria.
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Affiliation(s)
- Jing Xia
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Dongni Wu
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Kai Wu
- Department of Schistosomiasis and Endemic Diseases, Wuhan City Center for Disease Prevention and Control, Wuhan, China
| | - Hong Zhu
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Lingcong Sun
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Wen Lin
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Kaijie Li
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Juan Zhang
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Lun Wan
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Huaxun Zhang
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Si Liu
- Institute of Schistosomiasis Control, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
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13
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Li W, Zhang T, Xu X, Jiang J, Yu C, Tian C, Wang S, Lyu X, Liu Z. Problems Associated with the Diagnosis of Imported Malaria in Anhui Province, China. Am J Trop Med Hyg 2020; 102:142-146. [PMID: 31701862 DOI: 10.4269/ajtmh.19-0471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Imported malaria in Anhui Province, China, remains a significant public health issue with frequent reporting of severe and fatal cases, partly because of globalization and increased international communication. A retrospective evaluation using surveillance data from 2012 to 2018 was conducted to draw lessons on diagnosis of imported malaria. Epidemiological characteristics, together with diagnostic information, were analyzed using descriptive and comparative statistics. Simultaneously, blinded rechecking of malaria blood slides was performed at general hospitals in Anhui Province in 2018. The results showed that, in their first medical visits, 238 (28.2%) of 844 imported cases were not correctly diagnosed. Notably, the proportion of patients who were misdiagnosed at the first clinic visit was 104/120 (86.7%) at private and village clinics, and 41/81 (50.6%) at primary hospitals. The species identification rates for Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae were 85.2%, 66.7%, 23.2%, and 32.3% (χ2 = 224, P < 0.001), respectively. Nearly 7% of cases lacked laboratory evidence and were classified as presumed cases. Our findings suggest that physicians and health care providers, especially those at the primary level, lacked the awareness of diagnosing imported malaria. The training of physicians in malaria diagnosis needs to be enhanced. In addition, polymerase chain reactions (previously only carried out at the provincial level) should be performed at municipal CDC for rapid species identification, thereby guiding clinical treatment.
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Affiliation(s)
- Weidong Li
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Tao Zhang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Xian Xu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Jingjing Jiang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Chen Yu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Cuicui Tian
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Shuqi Wang
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Xiaofeng Lyu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Zhirong Liu
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
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14
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Lebut J, Mourvillier B, Argy N, Dupuis C, Vinclair C, Radjou A, de Montmollin E, Sinnah F, Patrier J, Le Bihan C, Magalahes E, Smonig R, Kendjo E, Thellier M, Ruckly S, Bouadma L, Wolff M, Sonneville R, Houzé S, Timsit JF. Changes in the clinical presentation and outcomes of patients treated for severe malaria in a referral French university intensive care unit from 2004 to 2017. Ann Intensive Care 2020; 10:21. [PMID: 32052207 PMCID: PMC7016155 DOI: 10.1186/s13613-020-0634-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 01/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In France, the incidence of severe imported malaria cases increased since early 2000. Artesunate was available (temporarily use authorization) since mid-2011 in France and commonly used for severe malaria since early 2013. Thus, the study objectives were to describe the patients with severe imported malaria admitted in intensive care unit (ICU) and assess the changes in clinical presentation and outcomes before and after this date. METHODS Retrospective observational single-center study in the infectious diseases ICU of a referral university hospital, conducted on patients admitted for severe imported malaria from 2004 to 2017. Demographic variables, severity scores, WHO's severity criteria on admission, treatment, and ICU and hospital lengths of stay were collected. Patients' characteristics and outcomes were compared between both periods. A poor outcome was defined as the composite endpoint of death, or requirement for vasopressors, invasive mechanical ventilation and/or renal replacement therapy. RESULTS 189 patients were included, 98 in 2004-2012 and 91 in 2013-2017, most often from West and Central African countries (96%). The number of WHO criteria for severe malaria was comparable in both groups, but SAPS II, SOFA and ICU length of stay were significantly higher in 2004-2012, while patients of African origin living in France were less frequent (p < 0.01). The outcome was poor for 41/98 cases in 2004-2012 and 12/91 cases in 2013-2017 (p < 0.01). The risk factors of poor outcome on the multivariate logistic regression were a neurological failure (adjusted odds ratio (adjOR = 3.23; 95% CI (1.03-10.08), p = 0.004), cardio-circulatory failure (adjOR = 9.92; 95% CI (2.34-42), p = <0.01) and creatinine blood levels > 265 µmol/L (adjOR = 10.76; 95% CI (3.17-36.53), p < 0.01). In the multivariate analysis, IV artesunate was not associated with a better outcome. Patients of African origin did not seem to have a better outcome than Caucasian patients or those from other origins (adjOR = 0.59; 95% CI (0.21-1.65), p = 0.31). CONCLUSION Patients with imported malaria admitted in ICU in 2013-2017 were less severely ill than those in 2004-2012. These trends could be partially explained by the increasing proportion of African patients visiting friends or relatives or living in endemic areas.
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Affiliation(s)
- Jordane Lebut
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- Longjumeau Hospital, ICU, Longjumeau, France
| | - Bruno Mourvillier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Nicolas Argy
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Claire Dupuis
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Camille Vinclair
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Aguila Radjou
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Etienne de Montmollin
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Fabrice Sinnah
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Juliette Patrier
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Clément Le Bihan
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Eric Magalahes
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Roland Smonig
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
| | - Eric Kendjo
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | - Marc Thellier
- UMRS 1136, iPLESP, Institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne Université, 27, Rue Chaligny, 75571, Paris 12, France
| | | | - Lila Bouadma
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Michel Wolff
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France
- University of Paris, IAME, INSERM, 75018, Paris, France
| | - Sandrine Houzé
- AP-HP, Bichat Hospital, Mycology Parasitology Department, Malaria National Reference Center, 75018, Paris, France
| | - Jean-François Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), University of Paris, IAME, INSERM U1137 (IAME), 75018, Paris, France.
- University of Paris, IAME, INSERM, 75018, Paris, France.
- OUTCOMEREA Research Network, Drancy, France.
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15
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Izri A, Cojean S, Leblanc C, Cohen Y, Bouchaud O, Durand R. Plasmodium vivax severe imported malaria in two migrants in France. Malar J 2019; 18:422. [PMID: 31842880 PMCID: PMC6916050 DOI: 10.1186/s12936-019-3067-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With less than one severe case per year in average, Plasmodium vivax is very rarely associated with severe imported malaria in France. Two cases of P. vivax severe malaria occurred in patients with no evident co-morbidity. Interestingly, both cases did not occur at the primary infection but during relapses. CASE PRESENTATIONS Patient 1: A 27-year old male, born in Afghanistan and living in France since 2012, was admitted on August 2015 to the Avicenne hospital because of abdominal pain, intense headache, fever and hypotension. The patient was haemodynamically unstable despite 5 L of filling solution. A thin blood film showed P. vivax trophozoites within the red blood cells. To take care of the septic shock, the patient was given rapid fluid resuscitation, norepinephrine (0.5 mg/h), and intravenous artesunate. Nested polymerase chain reactions of the SSUrRNA gene were negative for Plasmodium falciparum but positive for P. vivax. The patient became apyretic in less than 24H and the parasitaemia was negative at the same time. Patient 2: A 24-year old male, born in Pakistan and living in France, was admitted on August 2016 because of fever, abdominal pain, headache, myalgia, and nausea. The last travel of the patient in a malaria endemic area occurred in 2013. A thin blood film showed P. vivax trophozoites within the red blood cells. The patient was treated orally by dihydroartemisinin-piperaquine and recovered rapidly. Nine months later, the patient returned to the hospital with a relapse of P. vivax malaria. The malaria episode was uncomplicated and the patient recovered rapidly. Three months later, the patient came back again with a third episode of P. vivax malaria. Following a rapid haemodynamic deterioration, the patient was transferred to the intensive care unit of the hospital. In all the patient received 10 L of filling solution to manage the septic shock. After 5 days of hospitalization and a specific treatment, the patient was discharged in good clinical conditions. CONCLUSION Clinicians should be aware of the potential severe complications associated with P. vivax in imported malaria, even though the primary infection is uncomplicated.
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Affiliation(s)
- Arezki Izri
- Service de Parasitologie- Mycologie, CHU Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009, Bobigny Cedex, France.,Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207-IHU Méditerranée Infection), Marseille, France.,UFR SMBH, Université Paris 13, Bobigny, France
| | - Sandrine Cojean
- UMR 8076 CNRS BioCIS, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.,Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Claire Leblanc
- Service de Pédiatrie générale, CHU Jean Verdier, Bondy, France
| | - Yves Cohen
- Réanimation Médico-Chirurgicale, CHU Avicenne, Bobigny, France
| | - Olivier Bouchaud
- Service de Maladies Infectieuses et Tropicales, CHU Avicenne, Bobigny, France
| | - Rémy Durand
- Service de Parasitologie- Mycologie, CHU Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009, Bobigny Cedex, France. .,UMR 8076 CNRS BioCIS, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France.
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16
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Zhang T, Xu X, Jiang J, Yu C, Tian C, Xie Q, Li W. Risk factors of severe imported malaria in Anhui province, China. Acta Trop 2019; 197:104934. [PMID: 30802426 DOI: 10.1016/j.actatropica.2019.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/17/2019] [Accepted: 02/17/2019] [Indexed: 12/16/2022]
Abstract
We aimed to determine risk factors for developing severe illness in patients infected with imported Plasmodium falciparum, and identify factors that can be implemented in preventive public health actions. Data of patients in Anhui province were collected from the China Information System for Disease Control and Prevention and Information System for Parasitic Disease Control and Prevention from 2012 to 2018. Epidemiological characteristics, clinical severity, and preventive measures were analyzed using descriptive statistics. Risk factors for severe malaria were identified by logistic regression. During the study period, 8.01% (53/662) of patients infected with P. falciparum developed severe malaria; the annual severe incidence rate varied from 5.93% to 10.77% and the fatality rate was 0.6%. Two models were built to analyze the delay from symptom onset to treatment; one analyzed data by stage, whereas the other analyzed data combined from all stages. In model 1, multivariate analysis identified misdiagnosis at first medical visit and patient delay as risk factors for severe malaria (odds ratio: 3.108 and 3.385, respectively, all p < 0.01). In model 2, overall delay was a significant factor of severe malaria onset (odds ratio: 4.719, p = 0.000). In both models, patients with a history of previous infection had a significantly reduced risk of developing severe malaria; high parasitemia (≥2.5%) was associated with an increased risk of severe infection. Delay between symptom onset and treatment was an important cause for development of severe disease in Anhui province. Measures to reduce delays should be used and implemented in preventive public health actions.
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17
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Rojo-Marcos G, Rubio-Muñoz JM, Angheben A, Jaureguiberry S, García-Bujalance S, Tomasoni LR, Rodríguez-Valero N, Ruiz-Giardín JM, Salas-Coronas J, Cuadros-González J, García-Rodríguez M, Molina-Romero I, López-Vélez R, Gobbi F, Calderón-Moreno M, Martin-Echevarría E, Elía-López M, Llovo-Taboada J. Prospective comparative multi-centre study on imported Plasmodium ovale wallikeri and Plasmodium ovale curtisi infections. Malar J 2018; 17:399. [PMID: 30376868 PMCID: PMC6208040 DOI: 10.1186/s12936-018-2544-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/22/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few previous retrospective studies suggest that Plasmodium ovale wallikeri seems to have a longer latency period and produces deeper thrombocytopaenia than Plasmodium ovale curtisi. Prospective studies were warranted to better assess interspecies differences. METHODS Patients with imported P. ovale spp. infection diagnosed by thick or thin film, rapid diagnostic test (RDT) or polymerase chain reaction (PCR) were recruited between March 2014 and May 2017. All were confirmed by DNA isolation and classified as P. o. curtisi or P. o. wallikeri using partial sequencing of the ssrRNA gene. Epidemiological, analytical and clinical differences were analysed by statistical methods. RESULTS A total of 79 samples (35 P. o. curtisi and 44 P. o. wallikeri) were correctly genotyped. Males predominate in wallikeri group (72.7%), whereas were 48.6% in curtisi group. Conversely, 74.3% of curtisi group were from patients of African ethnicity, whilst 52.3% of Caucasians were infected by P. o. wallikeri. After performing a multivariate analysis, more thrombocytopaenic patients (p = 0.022), a lower number of platelets (p = 0.015), a higher INR value (p = 0.041), and shorter latency in Caucasians (p = 0.034) were significantly seen in P. o. wallikeri. RDT sensitivity was 26.1% in P. o. curtisi and 42.4% in P. o. wallikeri. Nearly 20% of both species were diagnosed only by PCR. Total bilirubin over 3 mg/dL was found in three wallikeri cases. Two patients with curtisi infection had haemoglobin under 7 g/dL, one of them also with icterus. A wallikeri patient suffered from haemophagocytosis. Chemoprophylaxis failed in 14.8% and 35% of curtisi and wallikeri patients, respectively. All treated patients with various anti-malarials which included artesunate recovered. Diabetes mellitus was described in 5 patients (6.32%), 4 patients of wallikeri group and 1 curtisi. CONCLUSIONS Imported P. o. wallikeri infection may be more frequent in males and Caucasians. Malaria caused by P. o. wallikeri produces more thrombocytopaenia, a higher INR and shorter latency in Caucasians and suggests a more pathogenic species. Severe cases can be seen in both species. Chemoprophylaxis seems less effective in P. ovale spp. infection than in P. falciparum, but any anti-malarial drug is effective as initial treatment. Diabetes mellitus could be a risk factor for P. ovale spp. infection.
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Affiliation(s)
- Gerardo Rojo-Marcos
- Hospital Universitario Príncipe de Asturias, Ctra de Meco s/n, 28805, Alcalá de Henares, Madrid, Spain.
| | | | | | - Stephane Jaureguiberry
- Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | | | | | | | | | | | - Juan Cuadros-González
- Hospital Universitario Príncipe de Asturias, Ctra de Meco s/n, 28805, Alcalá de Henares, Madrid, Spain
| | | | | | | | - Federico Gobbi
- Ospedale Sacro Cuore - Don Calabria, Negrar, Verona, Italy
| | | | | | | | - José Llovo-Taboada
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
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Bruneel F, Raffetin A, Corne P, Llitjos JF, Mourvillier B, Argaud L, Wolff M, Laurent V, Jauréguiberry S. Management of severe imported malaria in adults. Med Mal Infect 2018; 50:213-225. [PMID: 30266432 DOI: 10.1016/j.medmal.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
Abstract
Severe malaria accounts for approximately 10% of all cases of imported malaria in France; cases are mainly due to Plasmodium falciparum, while other Plasmodium species are possible but uncommon (P. vivax, P. knowlesi, P. malariae, and P. ovale). On the basis of WHO criteria for endemic areas, the French criteria defining severe imported malaria in adults have been progressively adapted to the European healthcare level. Management of severe imported malaria is a diagnostic and treatment emergency and must be initially conducted in the intensive care unit. Anti-infective treatment is now based on intravenous artesunate, which must be available in every hospital of the country likely to receive severe imported malaria patients. Intravenous quinine is thus used as a second-line treatment and is restricted to limited indications. Critical care management of organ failure is essential, particularly in patients presenting with very severe malaria. To date, no adjunctive therapy (including exchange transfusion) has demonstrated clear beneficial effects.
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Affiliation(s)
- F Bruneel
- Réanimation médico-chirurgicale, hôpital Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - A Raffetin
- Médecine interne, maladies infectieuses et tropicales, CHI Villeneuve-Saint-Georges, 94190 Villeneuve-Saint-Georges, France
| | - P Corne
- Réanimation médicale, CHU de Montpellier, 34000 Montpellier, France
| | - J F Llitjos
- Réanimation médicale, CHU Cochin, 75014 Paris, France
| | - B Mourvillier
- Réanimation médicale et infectieuse, CHU Bichat-Claude-Bernard, 75018 Paris, France
| | - L Argaud
- Réanimation médicale, CHU Edouard-Herriot, 69000 Lyon, France
| | - M Wolff
- Réanimation médicale et infectieuse, CHU Bichat-Claude-Bernard, 75018 Paris, France
| | - V Laurent
- Réanimation médico-chirurgicale, hôpital Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - S Jauréguiberry
- Maladies infectieuses et tropicales, CHU Pitié-Salpêtrière, 75013 Paris, France
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Khuu D, Eberhard ML, Bristow BN, Javanbakht M, Ash LR, Shafir SC, Sorvillo FJ. Risk factors for severe malaria among hospitalized patients in the United States, 2000–2014. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Pagès F, Houze S, Kurtkowiak B, Balleydier E, Chieze F, Filleul L. Status of imported malaria on Réunion Island in 2016. Malar J 2018; 17:210. [PMID: 29793505 PMCID: PMC5968708 DOI: 10.1186/s12936-018-2345-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/07/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Autochthonous malaria has been eliminated from Réunion in 1979. To prevent secondary transmission and re-emergence of autochthonous malaria, permanent epidemiologic and entomological surveillance and vector control measures are conducted around imported malaria cases. Results of local malaria surveillance (clinical data and results of epidemiological and entomological investigations around cases) were collected for 2013-2016 and were analysed according to historical data and to the exchanges with malaria-affected areas (estimated by airport data). RESULTS Form 2013 to 2016, 95 imported malaria cases have been detected in Reunion Island: 42% of cases occurred in the area of repartition of Anopheles arabiensis, but Anopheles mosquitoes were present only around seven cases including one gametocyte carrier. No autochthonous or introduced case has occurred during this period. The lack of chemoprophylaxis or poor adherence was found in the majority (96%) of malaria cases between 2013 and 2016, regardless of trip type. Affinity tourism in Madagascar and Comoros was the cause of 65% of imported malaria cases. DISCUSSION The incidence of imported malaria and the incidence rate per 100,000 travellers has continuously decreased since 2001. Now with the drastic decrease of malaria transmission in the Comoros archipelago, most of imported malaria cases in Reunion Island have been contaminated in Madagascar. Immigrants regularly resident in Reunion Island, which travel to malaria endemic countries (mainly Madagascar) to visit their friends and relatives (VFRs) represent a high-risk group of contracting malaria. VFRs, low adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis are the main drivers of imported malaria in Reunion Island. Furthermore as previously described, some general practitioners in Reunion Island are always not sufficiently aware of the official recommendations for prescriptions of prophylactic treatments. CONCLUSION Social mobilization targeted on the Malagasy community in Reunion Island could help to decrease the burden of imported malaria in Reunion Island. Because of the low number of gametocyte carriers and the absence of an Anopheles mosquito population when most malaria cases were imported those last 4 years, the risk of the appearance of introduced malaria cases and indigenous malaria cases appears low in Reunion Island.
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Affiliation(s)
- Frédéric Pagès
- Santé Publique France, Cire Océan Indien, 2, bis avenue Georges Brassens-CS 61002, 97713, Saint-Denis Cedex 9, Saint-Denis, Réunion, France.
| | - Sandrine Houze
- CNR Paludisme-Laboratoire de Parasitologie, APHP, Hôpital Bichat, Paris, France.,UMR 216, Merit, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Brian Kurtkowiak
- Vector Control Department, Agence régionale de santé Océan Indien, Paris, Saint-Denis, Réunion, France
| | - Elsa Balleydier
- Santé Publique France, Cire Océan Indien, 2, bis avenue Georges Brassens-CS 61002, 97713, Saint-Denis Cedex 9, Saint-Denis, Réunion, France
| | - François Chieze
- Health Monitoring Department, Agence régionale de santé Océan Indien, Paris, Saint-Denis, Réunion, France
| | - Laurent Filleul
- Santé Publique France, Cire Océan Indien, 2, bis avenue Georges Brassens-CS 61002, 97713, Saint-Denis Cedex 9, Saint-Denis, Réunion, France
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21
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Bruneel F, Raffetin A, Roujansky A, Corne P, Tridon C, Llitjos JF, Mourvillier B, Laurent V, Jauréguiberry S. Prise en charge du paludisme grave d’importation de l’adulte. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
En France, le paludisme grave d’importation concerne environ 12 à 14 % des accès palustres et implique très majoritairement Plasmodium falciparum. À partir de la définition du paludisme grave de l’Organisation mondiale de la santé utilisée en zone d’endémie palustre, la définition française du paludisme grave d’importation de l’adulte a été adaptée aux données et au contexte européens. La prise en charge du paludisme grave est une urgence diagnostique et thérapeutique qui doit être réalisée initialement en réanimation. Le traitement curatif du paludisme grave d’importation repose maintenant sur l’artésunate intraveineux (IV) qui doit être disponible dans chaque hôpital susceptible de recevoir ces patients. Dès lors, la quinine IV devient un traitement de seconde ligne réservé à quelques circonstances. La prise en charge symptomatique des défaillances d’organes est primordiale, notamment au cours des formes les plus sévères. Enfin, aucun traitement adjuvant n’a prouvé, à ce jour, son efficacité en pratique clinique.
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Time delays in the diagnosis and treatment of malaria in non-endemic countries: A systematic review. Travel Med Infect Dis 2018; 21:21-27. [DOI: 10.1016/j.tmaid.2017.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/28/2017] [Accepted: 12/04/2017] [Indexed: 11/19/2022]
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Wyss K, Wångdahl A, Vesterlund M, Hammar U, Dashti S, Naucler P, Färnert A. Obesity and Diabetes as Risk Factors for Severe Plasmodium falciparum Malaria: Results From a Swedish Nationwide Study. Clin Infect Dis 2017; 65:949-958. [PMID: 28510633 PMCID: PMC5848256 DOI: 10.1093/cid/cix437] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/07/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Noncommunicable diseases and obesity are increasing in prevalence globally, also in populations at risk of malaria. We sought to investigate if comorbidity, in terms of chronic diseases and obesity, is associated with severe Plasmodium falciparum malaria. METHODS We performed a retrospective observational study in adults (≥18 years of age) diagnosed with malaria in Sweden between January 1995 and May 2015. We identified cases through the surveillance database at the Public Health Agency of Sweden and reviewed clinical data from 18 hospitals. Multivariable logistic regression was used to assess associations between comorbidities and severe malaria. RESULTS Among 937 adults (median age, 37 years; 66.5% were male), patients with severe malaria had higher prevalence of chronic diseases (28/92 [30.4%]) compared with nonsevere cases (151/845 [17.9%]) (P = .004). Charlson comorbidity score ≥1 was associated with severe malaria (adjusted odds ratio [aOR], 2.63 [95% confidence interval {CI}, 1.45-4.77), as was diabetes among individual diagnoses (aOR, 2.98 [95% CI, 1.25-7.09]). Median body mass index was higher among severe (29.3 kg/m2) than nonsevere cases (24.7 kg/m2) (P < .001). Obesity was strongly associated with severe malaria, both independently (aOR, 5.58 [95% CI, 2.03-15.36]) and in combination with an additional metabolic risk factor (hypertension, dyslipidemia, or diabetes) (aOR, 6.54 [95% CI, 1.87-22.88]). The associations were observed among nonimmune travelers as well as immigrants from endemic areas. CONCLUSIONS Comorbidities, specifically obesity and diabetes, are previously unidentified risk factors for severe malaria in adults diagnosed with P. falciparum. Noncommunicable diseases should be considered in the acute management and prevention of malaria.
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Affiliation(s)
- Katja Wyss
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Emergency Medicine and
- Infectious Diseases, Karolinska University Hospital, Stockholm
| | - Andreas Wångdahl
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Department of Infectious Diseases, Västerås Central Hospital, and
| | - Maria Vesterlund
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
| | - Ulf Hammar
- Unit of Biostatistics, Department of Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Saduddin Dashti
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
| | - Pontus Naucler
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Infectious Diseases, Karolinska University Hospital, Stockholm
| | - Anna Färnert
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, and Departments of
- Infectious Diseases, Karolinska University Hospital, Stockholm
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Antinori S, Corona A, Castelli A, Rech R, Borghi B, Giannotti C, Colombo R, Fossali T, Ballone E, Minari C, Perotti A, Bergomi P, Galimberti L, Milazzo L, Ricaboni D, Scorza D, Grande R, Genderini F, Ieri M, Raimondi F, Catena E, Galli M, Corbellino M. Severe Plasmodium falciparum malaria in the intensive care unit: A 6-year experience in Milano, Italy. Travel Med Infect Dis 2017; 17:43-49. [PMID: 28554853 DOI: 10.1016/j.tmaid.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/02/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Severe imported Plasmodium falciparum malaria is a potentially life-threatening disease with a reported mortality rate of 5-10% when patients are admitted to the Intensive Care Unit. METHODS To retrospectively review the clinical aspects, the value of severity predictive scores and the management of patients with severe P. falciparum malaria admitted to an ICU in Milano, Italy between January 2010 and December 2015. RESULTS Twelve patients were included: seven were male and five female with a median age of 43 years. All were initially treated with intravenous quinine. Median parasitaemia upon admission was 14,5% (range 1-20%). At the time of ICU admission, 3 patients (25%) had 5 or more World Health Organization criteria for severe malaria while another 6 of them developed one or more of the latter during their stay in ICU. Five required mechanical ventilation because of respiratory failure due to ARDS. Four patients required renal replacement therapy. Three patients underwent blood exchange transfusion. All patients survived. CONCLUSIONS Our retrospective evaluation of adults patients admitted to the ICU with severe imported P. falciparum malaria demonstrated a favourable outcome. Severity predictive scores currently in use probably overestimate the risk of malaria mortality in patients treated in health care systems of high income countries.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy.
| | - Alberto Corona
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Antonio Castelli
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Roberto Rech
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Beatrice Borghi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Claudia Giannotti
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Riccardo Colombo
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Tommaso Fossali
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Elisabetta Ballone
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Caterina Minari
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Andrea Perotti
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Paola Bergomi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Laura Milazzo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Davide Ricaboni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Daniele Scorza
- Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Romualdo Grande
- Department of Diagnostic Services, Clinical Microbiology, Virology and Bioemergence Diagnostics, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Francesco Genderini
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Marco Ieri
- Hematology and Transfusion Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Ferdinando Raimondi
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Emanuele Catena
- Intensive Care Unit 1, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Massimo Galli
- Department of Clinical and Biomedical Sciences Luigi Sacco, University of Milano, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
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Argy N, Kendjo E, Augé-Courtoi C, Cojean S, Clain J, Houzé P, Thellier M, Hubert V, Deloron P, Houzé S. Influence of host factors and parasite biomass on the severity of imported Plasmodium falciparum malaria. PLoS One 2017; 12:e0175328. [PMID: 28410415 PMCID: PMC5391917 DOI: 10.1371/journal.pone.0175328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/23/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Imported malaria in France is characterized by various clinical manifestations observed in a heterogeneous population of patients such as travelers/expatriates and African migrants. In this population, host factors and parasite biomass associated with severe imported malaria are poorly known. METHODS From data collected by the Centre National de Référence du Paludisme, we identified epidemiological, demographic and biological features including parasite biomass and anti-plasmodial antibody levels (negative, positive and strongly positive serology) associated with different disease severity groups (very severe, moderately severe, and uncomplicated malaria) in 3 epidemiological groups (travelers/expatriates, first- and second-generation migrants). RESULTS Age, ethnicity, absence of prior infection with P. falciparum, antibody levels, plasma PfHRP2 levels, total and circulating parasite biomass were related to severe malaria onset. Sequestered parasite biomass tended to be increased in very severe malaria, and was strongly correlated to the antibody level of the host. CONCLUSIONS Prior exposure to P. falciparum is associated with high anti-plasmodial antibody levels which influence clinical presentation of imported malaria and its correlated circulating and sequestered parasite burden.
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Affiliation(s)
- Nicolas Argy
- Laboratoire de parasitologie, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Eric Kendjo
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Claire Augé-Courtoi
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Sandrine Cojean
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Jérôme Clain
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Pascal Houzé
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- Laboratoire de pharmacologie, hôpital Saint-Louis, APHP, Paris, France
| | - Marc Thellier
- Laboratoire de parasitologie, hôpital Pitié-Salpêtrière, APHP, Paris, France
- Faculté de Médecine, Université Pierre et Marie Curie, COMUE Sorbonne Paris Cité, Paris, France
| | - Veronique Hubert
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
| | - Philippe Deloron
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
| | - Sandrine Houzé
- Laboratoire de parasitologie, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Centre National de Référence du Paludisme, hôpital Bichat-Claude Bernard, APHP, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, COMUE Sorbonne Paris Cité, Paris, France
- UMR MERIT 216, Institut de recherche pour le développement, Paris, France
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Casalino E, Etienne A, Mentré F, Houzé S. Hospitalization and ambulatory care in imported-malaria: evaluation of trends and impact on mortality. A prospective multicentric 14-year observational study. Malar J 2016; 15:312. [PMID: 27267597 PMCID: PMC4897798 DOI: 10.1186/s12936-016-1364-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalization is usually recommended for imported malaria. The goal of the present study is to evaluate the evolution in clinical pathways while measuring their impact on mortality. METHODS This is a 14-year prospective observational study divided into three periods. We evaluated for adult (≥15 years) and paediatric (<15 years) case trends in severity, clinical pathways (hospitalization in medical ward (MW) or intensive care unit (ICU), ambulatory care) and mortality. RESULTS In total, 21,386 imported malaria cases were included, 4269 of them were paediatrics (20 %). Rises in severe forms for adults [from 8 % in period 1-14 % in period 3 (p = 0.0001)] and paediatrics [from 12 to 18 % (p < 0.0001)] were found. For adults, MW admission rates decreased [-15 % (CI 95 % -17; -13)] while ambulatory care [+7 % (CI 95 % 5-9)] and ICU admission rates [+4 % (CI 95 % 3-5)] increased. For paediatrics, increase in ICU admissions (+3 %) was shown. We did not observe any change in overall mortality during the study periods, whether among adults or children, regardless of care pathway. CONCLUSIONS The present study indicates a changing management of imported malaria in adults, with an increasing trend for ambulatory care. The absence of change in mortality for adults indicates that ambulatory care can be proposed for adults presenting non-severe imported malaria.
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Affiliation(s)
- Enrique Casalino
- />Service d’Accueil des Urgences, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
- />Université Paris Diderot, PRES Sorbonne Paris Cité, EA 7334 «Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES)», Paris, France
| | - Aurélie Etienne
- />INSERM, IAME, UMR 1137, 75018 Paris, France
- />Service de Biostatistique, AP-HP, Hôpital Bichat, 75018 Paris, France
| | - France Mentré
- />INSERM, IAME, UMR 1137, 75018 Paris, France
- />Service de Biostatistique, AP-HP, Hôpital Bichat, 75018 Paris, France
- />Université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Sandrine Houzé
- />Parasitology Laboratory, Centre National de Référence du Paludisme, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France
- />RD UMR216, Mère et enfant face aux infections tropicales, 75006 Paris, France
- />Faculté des Sciences Pharmaceutiques et Biologiques, PRES Sorbonne Paris Cité, Université Paris Descartes, 75270 Paris, France
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Francis BC, Gonzalo X, Duggineni S, Thomas JM, NicFhogartaigh C, Babiker ZOE. Epidemiology and clinical features of imported malaria in East London. J Travel Med 2016; 23:taw060. [PMID: 27601534 DOI: 10.1093/jtm/taw060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/11/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Malaria is the most common imported tropical disease in the United Kingdom (UK). The overall mortality is low but inter-regional differences have been observed. METHODS We conducted a 2-year retrospective review of clinical and laboratory records of patients with malaria attending three acute hospitals in East London from 1 April 2013 through 31 March 2015. Epidemiological and clinical characteristics of imported malaria were described and risk factors associated with severe falciparum malaria were explored. RESULTS In total, 133 patients with laboratory-confirmed malaria were identified including three requiring critical care admission but no deaths. The median age at presentation was 41 years (IQR 30-50). The majority of patients were males (64.7%, 86/133) and had Black or Black British ethnicity (67.5%, 79/117). West Africa was the most frequent region of travel (70.4%, 76/108). Chemoprophylaxis use was poor (25.3%, 20/79). The interval between arriving in the UK and presenting to hospital was short (median 10 days; IQR 5-15.5, n = 84). July-September was the peak season of presentation (34.6%, 46/133). Plasmodium falciparum was the commonest species (76.7%, 102/133) and 31.4% (32/102) of these patients had parasitaemia >2%. Severe falciparum malaria was documented in 36.3% (37/102) of patients and the October-March season presentation was associated with an increased risk of severity (OR 3.00; 95% CI 1.30-6.93). Black patients appeared to have reduced risk of severe falciparum malaria (OR 0.46; 95% CI 0.16-1.35) but this was not statistically significant. HIV sero-status was determined in only 27.1% (36/133) of cases. Only 8.5% (10/117) of all malaria patients were treated as outpatients. CONCLUSION Clinicians need to raise awareness on malaria prevention strategies, improve rates of HIV testing in tropical travellers, and familiarise themselves with ambulatory management of malaria. The relationship between season of presentation, ethnicity and severity of falciparum malaria should be explored further.
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Affiliation(s)
- Benjamin C Francis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Ximena Gonzalo
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
| | - Sirisha Duggineni
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Janice M Thomas
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Caoimhe NicFhogartaigh
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
| | - Zahir Osman Eltahir Babiker
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, 80 Newark Street, London, E1 2ES, UK
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Chin BS, Kim JY, Gianella S, Lee M. Travel Pattern and Prescription Analysis at a Single Travel Clinic Specialized for Yellow Fever Vaccination in South Korea. Infect Chemother 2016; 48:20-30. [PMID: 27104012 PMCID: PMC4835431 DOI: 10.3947/ic.2016.48.1.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/15/2015] [Accepted: 12/31/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Travel-related risks for infectious diseases vary depending on travel patterns such as purpose, destination, and duration. In this study, we describe the patterns of travel and prescription of vaccines as well as malaria prophylaxis medication (MPM) at a travel clinic in South Korea to identify the gaps to fill for the optimization of pre-travel consultation. MATERIALS AND METHODS A cohort of travel clinic visitors in 2011 was constructed and early one-third of the visitors of each month were reviewed. During the study period, 10,009 visited the travel clinic and a retrospective chart review was performed for 3,332 cases for analysis of travel patterns and prescriptions. RESULTS People receiving yellow fever vaccine (YFV) (n = 2,933) were traveling more frequently for business and tourism and less frequently for providing non-medical service or research/education compared to the 399 people who did not receive the YFV. Overall, most people were traveling to Eastern Africa, South America, and Western Africa, while South-Eastern Asia was the most common destination for the non-YFV group. Besides YFV, the typhoid vaccine was the most commonly prescribed (54.2%), while hepatitis A presented the highest coverage (74.7%) considering the natural immunity, prior and current vaccination history. Additionally, 402 (82.5%) individuals received a prescription for MPM among the 487 individuals travelling to areas with high-risk of malaria infection. Age over 55 was independently associated with receiving MPM prescription, while purpose of providing service and travel duration over 10 days were associated with no MPM prescription, despite travelling to high-risk areas. CONCLUSION Eastern Africa and South America were common travel destinations among the visitors to a travel clinic for YFV, and most of them were travelling for tourism and business. For the individuals who are traveling to areas with high-risk for malaria, more proactive approach might be required in case of younger age travelers, longer duration, and travel purpose of providing service to minimize the risk of malaria infection.
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Affiliation(s)
- Bum Sik Chin
- Center for Infectious Diseases, National Medical Center, Seoul, Korea
| | - Jae Yoon Kim
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Sara Gianella
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Myunghee Lee
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea
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Allen N, Bergin C, Kennelly SP. Malaria in the returning older traveler. Trop Dis Travel Med Vaccines 2016; 2:2. [PMID: 28883946 PMCID: PMC5588706 DOI: 10.1186/s40794-016-0018-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 01/28/2016] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Increased co-morbidities and physiological changes mean older patients may be at higher risk of adverse outcomes from certain imported illnesses. One of the most commonly diagnosed imported infections in returning travelers is malaria. Increasing age is strongly and independently associated with increasing morbidity and mortality from malaria. Delayed diagnosis leads to higher risks of poor clinical outcomes in older patients presenting with malaria. The objective of this study was to quantify malaria presentations in older patients as a percentage of total malaria presentations, compare length of hospital stay (LOS) between the older and younger cohort, and to describe medical co-morbidities, length of time to diagnosis and factors contributing to delayed diagnosis and increased LOS in the older cohort. METHODS A retrospective cohort study was undertaken in two university hospitals of all patients aged 65 years or older presenting with malaria from 2002-2012. A national hospital inpatient database was used to identify patients of all ages with a discharge diagnosis of malaria over this ten year period, and quantify LOS in those aged <65 and those aged 65 years or older. The case-notes for all of the older cohort were reviewed. RESULTS There were a total of 203 cases, 12 of whom were aged ≥65 years (5.9 %- total). Median time to diagnosis in this older group was two days (range 0-35), median LOS was eight days (range 1-77), compared to a median LOS of three days in those aged <65 years. All patients aged ≥65 years presented with fever. Travel history was documented in only 6/12 charts, and 11/12 had two or more co-morbid illnesses. Six of the 12 patients were not diagnosed or treated within 48 h of presentation. CONCLUSIONS This case series highlights the need for appropriate history-taking and timely diagnosis of the older traveler returning with fever, as delayed diagnosis and treatment can contribute to prolonged hospital stay and increased morbidity. With increasing numbers of older travelers, physicians must remain vigilant to the presence of imported illnesses, particularly malaria, in older patients with unexplained fever.
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Affiliation(s)
- N Allen
- Department of Genitourinary medicine and Infectious Diseases, St. James’s Hospital, Dublin 8, Ireland
| | - C Bergin
- Department of Genitourinary medicine and Infectious Diseases, St. James’s Hospital, Dublin 8, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - SP Kennelly
- Department of Age Related Healthcare, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Jauréguiberry S, Thellier M, Ndour PA, Ader F, Roussel C, Sonneville R, Mayaux J, Matheron S, Angoulvant A, Wyplosz B, Rapp C, Pistone T, Lebrun-Vignes B, Kendjo E, Danis M, Houzé S, Bricaire F, Mazier D, Buffet P, Caumes E. Delayed-onset hemolytic anemia in patients with travel-associated severe malaria treated with artesunate, France, 2011-2013. Emerg Infect Dis 2016; 21:804-12. [PMID: 25898007 PMCID: PMC4412216 DOI: 10.3201/eid2105.141171] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Artesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate.
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Pelfrene E, Pinheiro MH, Cavaleri M. Artemisinin-based combination therapy in the treatment of uncomplicated malaria: review of recent regulatory experience at the European Medicines Agency. Int Health 2015; 7:239-46. [PMID: 25855638 PMCID: PMC4492341 DOI: 10.1093/inthealth/ihv017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/03/2014] [Accepted: 12/12/2014] [Indexed: 11/13/2022] Open
Abstract
Malaria remains a major public health challenge with almost half of the world's population exposed to the risk of contracting the illness. Prompt, effective and well tolerated treatment remains one of the cornerstones in the disease management, with artemisinin-based combination therapy the recommended option for non-severe malaria in endemic areas with predominant Plasmodium falciparum infections.Recent experience has been obtained at the European Medicines Agency with regulatory approval of two such antimalarial fixed combination products. For these cases, two different regulatory pathways were applied. As such, the present contribution describes this experience, emphasising main differences and applicability offered by these regulatory choices.
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Affiliation(s)
- Eric Pelfrene
- Office of Anti-infectives and Vaccines, Human Medicines Evaluation Division
| | - Marie-Hélène Pinheiro
- Office of Regulatory Affairs, Human Medicines Research and Development Support Division; European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK
| | - Marco Cavaleri
- Office of Anti-infectives and Vaccines, Human Medicines Evaluation Division
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Muñoz J, Rojo-Marcos G, Ramírez-Olivencia G, Salas-Coronas J, Treviño B, Perez Arellano JL, Torrús D, Muñoz Vilches MJ, Ramos JM, Alegría I, López-Vélez R, Aldasoro E, Perez-Molina JA, Rubio JM, Bassat Q. Diagnóstico y tratamiento de la malaria importada en España: recomendaciones del Grupo de Trabajo de Malaria de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI). Enferm Infecc Microbiol Clin 2015; 33:e1-e13. [DOI: 10.1016/j.eimc.2013.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/21/2013] [Accepted: 12/25/2013] [Indexed: 01/05/2023]
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Pinsent A, Read JM, Griffin JT, Smith V, Gething PW, Ghani AC, Pasvol G, Hollingsworth TD. Risk factors for UK Plasmodium falciparum cases. Malar J 2014; 13:298. [PMID: 25091803 PMCID: PMC4132200 DOI: 10.1186/1475-2875-13-298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 07/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increasing proportion of malaria cases diagnosed in UK residents with a history of travel to malaria endemic areas are due to Plasmodium falciparum. METHODS In order to identify travellers at most risk of acquiring malaria a proportional hazards model was used to estimate the risk of acquiring malaria stratified by purpose of travel and age whilst adjusting for entomological inoculation rate (EIR) and duration of stay in endemic countries. RESULTS Travellers visiting friends and relatives and business travellers were found to have significantly higher hazard of acquiring malaria (adjusted hazard ratio (HR) relative to that of holiday makers 7.4, 95% CI 6.4-8.5, p < 0. 0001 and HR 3.4, 95% CI 2.9-3.8, p < 0. 0001, respectively). All age-groups were at lower risk than children aged 0-15 years. CONCLUSIONS These estimates of the increased risk for business travellers and those visiting friends and relatives should be used to inform programmes to improve awareness of the risks of malaria when travelling.
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Schlagenhauf P, Petersen E. Standby emergency treatment of malaria in travelers: experience to date and new developments. Expert Rev Anti Infect Ther 2014; 10:537-46. [PMID: 22702318 DOI: 10.1586/eri.12.42] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland.
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Mandal S. Epidemiological aspects of vivax and falciparum malaria: global spectrum. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60410-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Pistone T, Diallo A, Mechain M, Receveur MC, Malvy D. Epidemiology of imported malaria give support to the hypothesis of 'long-term' semi-immunity to malaria in sub-Saharan African migrants living in France. Travel Med Infect Dis 2013; 12:48-53. [PMID: 24041779 DOI: 10.1016/j.tmaid.2013.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 08/09/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Short-term semi-immunity to malaria in sub-Saharan African migrants who have recently arrived in non-endemic countries results in less severe imported malaria. Our aim was to investigate the factors associated with imported malaria that would favour the hypothesis of a 'long-term' semi-immunity to malaria in adult travellers of sub-Saharan origin living in France and visiting family or relatives in their country of origin (VFR group). METHOD The epidemiological, clinical and biological characteristics of imported Plasmodium falciparum malaria in VFR were compared with those of travellers of European origin (TEO). Newly arrived African migrants and European expatriates were excluded. RESULTS This retrospective study included 106 adult VFR (30%) and 240 adult TEO (70%) with imported P. falciparum malaria treated at the University Hospital Center of Bordeaux between 2000 and 2007. The main regions visited were West Africa (58%) and Central Africa (34%). P. falciparum was associated with severe malaria in 8% of patients (VFR 3% vs. TEO 11%), of which two TEO died. In univariate analysis, the factors associated with P. falciparum malaria in VFR vs. TEO were: female sex, younger age, less frequent use of mosquito nets, poor compliance with chemoprophylaxis, less severe malaria without death, less severe thrombocytopenia and a tendency towards a lower level of parasitaemia and higher haemoglobinaemia. In multivariate analysis, the only factor to be independently associated with P. falciparum malaria in VFR compared to TEO was less frequent severe malaria. CONCLUSIONS Our results give support to the hypothesis of 'long-term' semi-immunity to malaria in VFR living in France.
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Affiliation(s)
- T Pistone
- Travel Clinic and Division of Clinical Tropical Medicine, Department of Tropical Diseases, University Hospital Center of Bordeaux, France; Centre René Labusquière, Centre for Tropical Medicine, Université Victor Segalen, Bordeaux, France.
| | - A Diallo
- Centre René Labusquière, Centre for Tropical Medicine, Université Victor Segalen, Bordeaux, France
| | - M Mechain
- Travel Clinic and Division of Clinical Tropical Medicine, Department of Tropical Diseases, University Hospital Center of Bordeaux, France
| | - M-C Receveur
- Travel Clinic and Division of Clinical Tropical Medicine, Department of Tropical Diseases, University Hospital Center of Bordeaux, France; Centre René Labusquière, Centre for Tropical Medicine, Université Victor Segalen, Bordeaux, France
| | - D Malvy
- Travel Clinic and Division of Clinical Tropical Medicine, Department of Tropical Diseases, University Hospital Center of Bordeaux, France; Centre René Labusquière, Centre for Tropical Medicine, Université Victor Segalen, Bordeaux, France
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Abstract
Severe malaria is a medical emergency requiring early intervention to prevent death. This article highlights key aspects of the management of severe malaria syndromes in the intensive care unit, with a focus on individual case management of imported malaria. Key differences in the presentation, management, and outcomes of severe malaria by endemicity and by age group are emphasized. In all groups with severe malaria, intravenous artesunate is the antimalarial agent of choice. This article discusses specific antimalarial therapies, optimal supportive management strategies, differences from strategies for bacterial sepsis, and trials of adjunctive therapy for severe malaria in humans.
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Vliegenthart-Jongbloed K, de Mendonça Melo M, van Wolfswinkel ME, Koelewijn R, van Hellemond JJ, van Genderen PJJ. Severity of imported malaria: protective effect of taking malaria chemoprophylaxis. Malar J 2013; 12:265. [PMID: 23902640 PMCID: PMC3734097 DOI: 10.1186/1475-2875-12-265] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Although chemoprophylaxis remains an important strategy for preventing malaria in travellers, its effectiveness may be compromised by lack of adherence. Inappropriate use of chemoprophylaxis is likely to increase the risk of acquiring malaria, but may probably also worsen the severity of imported cases. The aim of this study was to assess the impact of use of malaria chemoprophylaxis on clinical features and outcome of imported malaria. Methods Demographic, clinical and laboratory data of patients included in the Rotterdam Malaria Cohort between 1998 and 2011 were systematically collected and analysed. Patients were classified as self-reported compliant or non-compliant users or as non-users of chemoprophylaxis. Severe malaria was defined using the 2010 WHO criteria. Results Details on chemoprophylaxis were available for 559 of the 604 patients, of which 64.6% were non-users, 17.9% were inadequate users and 17.5% reported to be adequate users. The group of non-users was predominated by patients with African ethnicity, partial immunity and people visiting friends and relatives. The majority contracted Plasmodium falciparum malaria. In contrast, compliant users acquired non-falciparum malaria more frequently, had significant lower P. falciparum loads on admission, shorter duration of hospitalization and significant lower odds for severe malaria as compared with non-users. Patients with P. falciparum malaria were more likely to have taken their chemoprophylaxis less compliantly than those infected with non-P. falciparum species. Multivariate analysis showed that self-reported adequate prophylaxis and being a partially immune traveller visiting friends and relatives was associated with significantly lower odds ratio of severe malaria. In contrast, age, acquisition of malaria in West-Africa and being a non-immune tourist increased their risk significantly. Conclusions Compliant use of malaria chemoprophylaxis was associated with significantly lower odds ratios for severe malaria as compared with non-compliant users and non-users of chemoprophylaxis. After correction for age, gender and immunity, this protective effect of malaria chemoprophylaxis was present only in individuals who adhered compliantly to use of chemoprophylaxis. Patients with P. falciparum malaria were more likely to have used their chemoprophylaxis less compliantly than patients with non-P. falciparum malaria who were more likely to have contracted malaria in spite of compliant use of chemoprophylaxis.
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Hunja CW, Unger H, Ferreira PE, Lumsden R, Morris S, Aman R, Alexander C, Mita T, Culleton R. Travellers as sentinels: Assaying the worldwide distribution of polymorphisms associated with artemisinin combination therapy resistance in Plasmodium falciparum using malaria cases imported into Scotland. Int J Parasitol 2013; 43:885-9. [PMID: 23899818 DOI: 10.1016/j.ijpara.2013.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/02/2013] [Accepted: 07/05/2013] [Indexed: 11/29/2022]
Abstract
There is growing evidence that Plasmodium falciparum parasites in southeastern Asia have developed resistance to artemisinin combination therapy. The resistance phenotype has recently been shown to be associated with four single nucleotide polymorphisms in the parasite's genome. We assessed the prevalence of two of these single nucleotide polymorphisms in P. falciparum parasites imported into Scotland between 2009 and 2012, and in additional field samples from six countries in southeastern Asia. We analysed 28 samples from 11 African countries, and 25 samples from nine countries in Asia/southeastern Asia/Oceania. Single nucleotide polymorphisms associated with artemisinin combination therapy resistance were not observed outside Thailand and Cambodia.
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Affiliation(s)
- Carol W Hunja
- Malaria Unit, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Polley SD, González IJ, Mohamed D, Daly R, Bowers K, Watson J, Mewse E, Armstrong M, Gray C, Perkins MD, Bell D, Kanda H, Tomita N, Kubota Y, Mori Y, Chiodini PL, Sutherland CJ. Clinical evaluation of a loop-mediated amplification kit for diagnosis of imported malaria. J Infect Dis 2013; 208:637-44. [PMID: 23633403 PMCID: PMC3719897 DOI: 10.1093/infdis/jit183] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. Diagnosis of malaria relies on parasite detection by microscopy or antigen detection; both fail to detect low-density infections. New tests providing rapid, sensitive diagnosis with minimal need for training would enhance both malaria diagnosis and malaria control activities. We determined the diagnostic accuracy of a new loop-mediated amplification (LAMP) kit in febrile returned travelers. Methods. The kit was evaluated in sequential blood samples from returned travelers sent for pathogen testing to a specialist parasitology laboratory. Microscopy was performed, and then malaria LAMP was performed using Plasmodium genus and Plasmodium falciparum–specific tests in parallel. Nested polymerase chain reaction (PCR) was performed on all samples as the reference standard. Primary outcome measures for diagnostic accuracy were sensitivity and specificity of LAMP results, compared with those of nested PCR. Results. A total of 705 samples were tested in the primary analysis. Sensitivity and specificity were 98.4% and 98.1%, respectively, for the LAMP P. falciparum primers and 97.0% and 99.2%, respectively, for the Plasmodium genus primers. Post hoc repeat PCR analysis of all 15 tests with discrepant results resolved 4 results in favor of LAMP, suggesting that the primary analysis had underestimated diagnostic accuracy. Conclusions. Malaria LAMP had a diagnostic accuracy similar to that of nested PCR, with a greatly reduced time to result, and was superior to expert microscopy.
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Affiliation(s)
- Spencer D Polley
- Department of Clinical Parasitology, Walk-in Clinic, Hospital for Tropical Diseases, University London Colleges NHS Foundation Trust, Mortimer Market, London WC1E 6JB, UK
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Siikamäki H, Kivelä P, Lyytikäinen O, Kantele A. Imported malaria in Finland 2003-2011: prospective nationwide data with rechecked background information. Malar J 2013; 12:93. [PMID: 23497115 PMCID: PMC3623624 DOI: 10.1186/1475-2875-12-93] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 01/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although described in several reports, imported malaria in Europe has not been surveyed nationwide with overall coverage of patients and individually rechecked background information. Plasmodium falciparum infections have been reported despite regularly taken appropriate chemoprophylaxis, yet the reliability of such questionnaire-based retrospective data has been questioned. This was the starting-point for conducting a prospective nationwide survey of imported malaria where compliance data was double-checked. METHODS Data was collected on all cases of imported malaria confirmed and recorded by the reference laboratory of Finland (population 5.4 million) from 2003 to 2011, and these were compared with those reported to the National Infectious Disease Register (NIDR). Background information was gathered by detailed questionnaires sent to the clinicians upon diagnosis; missing data were enquired by telephone of clinician or patient. Special attention was paid to compliance with chemoprophylaxis: self-reported use of anti-malarials was rechecked for all cases of P. falciparum. RESULTS A total of 265 malaria cases (average annual incidence rate 0.5/100,000 population) had been recorded by the reference laboratory, all of them also reported to NIDR: 54% were born in malaria-endemic countries; 86% were currently living in non-endemic regions. Malaria was mainly (81%) contracted in sub-Saharan Africa. Plasmodium falciparum proved to be the most common species (72%). Immigrants constituted the largest group of travellers (44%). Pre-travel advice was received by 20% of those born in endemic regions and 81% of those from non-endemic regions. Of those with P. falciparum, 4% reported regular use of appropriate chemoprophylaxis (mefloquine or atovaquone/proguanil or doxycycline for regions with chloroquine-resistant and atovaquone/proguanil or doxycycline for regions with mefloquine-resistant P. falciparum); after individual rechecking, however, it was found that none of them had been fully compliant. CONCLUSIONS Information on compliance with chemoprophylactic regimen cannot be relied on, and it should be rechecked if malaria is suspected. The results of the present study suggest that mefloquine, atovaquone/proguanil and doxycycline are effective as chemoprophylaxis against P. falciparum malaria, when taken conscientiously.
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Affiliation(s)
- Heli Siikamäki
- Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital, Aurora Hospital, Helsinki FI-00029, HUS, Finland.
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Jelinek T. Artemisinin based combination therapy in travel medicine. Travel Med Infect Dis 2013; 11:23-8. [PMID: 23465532 DOI: 10.1016/j.tmaid.2013.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 01/25/2013] [Accepted: 01/25/2013] [Indexed: 12/13/2022]
Abstract
A steadily increasing number of Western travellers are exposed to malaria. Also, numbers of migrants from malarious areas are increasing. Fast and effective treatment options are needed to ensure effective malaria treatment in these groups in the future. Artemisinin combinations are well tolerated and have shown high efficacy in malaria endemic areas. Since 2001, 42 malaria endemic countries, 23 of them in Africa, have adopted artemisinin based combination therapies recommended by WHO. An additional 14 countries are in the process of changing their malaria treatment policy. Studies in non-immune travellers confirm a rapid parasite clearance time and very low rate of side effects. Outpatient clinics and hospitals in non-endemic countries should have standard operating procedures for diagnosing and managing patients with malaria. In this setting, artemisinin combinations should be available for treatment of uncomplicated malaria as they are clearly superior to any other oral antimalarial in their fast reduction of parasite biomass and in decreasing clinical symptoms. Also, they are the drugs of choice for travellers who are advised to carry stand-by emergency treatment during their journey.
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Affiliation(s)
- Tomas Jelinek
- Berlin Center for Travel & Tropical Medicine, Berlin, Germany.
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Marks ME, Armstrong M, Suvari MM, Batson S, Whitty CJM, Chiodini PL, Bellinghan G, Doherty JF. Severe imported falciparum malaria among adults requiring intensive care: a retrospective study at the hospital for tropical diseases, London. BMC Infect Dis 2013; 13:118. [PMID: 23497139 PMCID: PMC3599148 DOI: 10.1186/1471-2334-13-118] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/27/2013] [Indexed: 11/25/2022] Open
Abstract
Background Malaria is the commonest imported infection in the UK. Malaria requiring ICU admission has a reported mortality of up to 25%. The relationship between ethnicity, immunity, and risk of malaria is complex. The Malaria Score for Adults (MSA) and Coma Acidosis Malaria (CAM) score have recently been proposed to risk stratify patients with malaria. Methods Retrospective study of patients with WHO severe falciparum malaria admitted to ICU at the Hospital for Tropical Diseases, London, UK. The relationship between clinical variables and risk of death or a prolonged ICU stay were examined with logistic regression. The predictive value of the MSA and CAM score were calculated. Results 124 patients were included. Cerebral malaria and acute kidney injury occurred earlier (median day 1) than acute respiratory distress syndrome (median day 3). Six patients had community acquired bacterial co-infection. Eight patients were co-infected with HIV, five of whom were newly diagnosed. The positive predictive value of a CAM score ≥2 or an MSA ≥5 for death were 12% and 22% respectively. Five patients died. No variable was significantly associated with risk of death. There were no significant differences between individuals raised in endemic countries compared to non-endemic countries. Conclusions Mortality in patients managed in a specialist centre was low. Patients who died succumbed to complications associated with a prolonged stay on ICU rather than malaria per se. The clinical usefulness of the MSA and CAM score was limited. Co-infection with HIV was relatively common but compared to studies in children, bacteraemia was uncommon. The relationship between ethnicity and immunity to severe disease is complex.
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Affiliation(s)
- Michael E Marks
- The Hospital for Tropical Diseases, Mortimer Market Centre, Capper Street, WC1E 6JB, London, UK
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Askling HH, Bruneel F, Burchard G, Castelli F, Chiodini PL, Grobusch MP, Lopez-Vélez R, Paul M, Petersen E, Popescu C, Ramharter M, Schlagenhauf P. Management of imported malaria in Europe. Malar J 2012; 11:328. [PMID: 22985344 PMCID: PMC3489857 DOI: 10.1186/1475-2875-11-328] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 08/19/2012] [Indexed: 11/10/2022] Open
Abstract
In this position paper, the European Society for Clinical Microbiology and Infectious Diseases, Study Group on Clinical Parasitology, summarizes main issues regarding the management of imported malaria cases. Malaria is a rare diagnosis in Europe, but it is a medical emergency. A travel history is the key to suspecting malaria and is mandatory in patients with fever. There are no specific clinical signs or symptoms of malaria although fever is seen in almost all non-immune patients. Migrants from malaria endemic areas may have few symptoms.Malaria diagnostics should be performed immediately on suspicion of malaria and the gold- standard is microscopy of Giemsa-stained thick and thin blood films. A Rapid Diagnostic Test (RDT) may be used as an initial screening tool, but does not replace urgent microscopy which should be done in parallel. Delays in microscopy, however, should not lead to delayed initiation of appropriate treatment. Patients diagnosed with malaria should usually be hospitalized. If outpatient management is preferred, as is the practice in some European centres, patients must usually be followed closely (at least daily) until clinical and parasitological cure. Treatment of uncomplicated Plasmodium falciparum malaria is either with oral artemisinin combination therapy (ACT) or with the combination atovaquone/proguanil. Two forms of ACT are available in Europe: artemether/lumefantrine and dihydroartemisinin/piperaquine. ACT is also effective against Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi, but these species can be treated with chloroquine. Treatment of persistent liver forms in P. vivax and P. ovale with primaquine is indicated after excluding glucose 6 phosphate dehydrogenase deficiency. There are modified schedules and drug options for the treatment of malaria in special patient groups, such as children and pregnant women. The potential for drug interactions and the role of food in the absorption of anti-malarials are important considerations in the choice of treatment.Complicated malaria is treated with intravenous artesunate resulting in a much more rapid decrease in parasite density compared to quinine. Patients treated with intravenous artesunate should be closely monitored for haemolysis for four weeks after treatment. There is a concern in some countries about the lack of artesunate produced according to Good Manufacturing Practice (GMP).
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Affiliation(s)
- Helena H Askling
- Department of Medicine Solna/Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Fabrice Bruneel
- Intensive Care Unit, Centre Hospitalier de Versailles, Site André Mignot, 177 rue de Versailles, Le Chesnay 78150, France
| | - Gerd Burchard
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Peter L Chiodini
- Hospital for Tropical Diseases and London School of Hygiene and Tropical Medicine, London, UK
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rogelio Lopez-Vélez
- Tropical Medicine & Clinical Parasitology. Infectious Diseases Department.Hospital Ramón y Cajal, Madrid, Spain
| | - Margaret Paul
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Corneliu Popescu
- Clinical Hospital of Infectious and Tropical Diseases "Dr.Victor Babes", University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Michael Ramharter
- Department. of Medicine I, Div. of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Patricia Schlagenhauf
- University of Zürich, Centre for Travel Medicine, Division of Epidemiology and Communicable Diseases, Zürich, Switzerland
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Abstract
A common approach to malaria prevention is to follow the "A, B, C, D" rule: Awareness of risk, Bite avoidance, Compliance with chemoprophylaxis, and prompt Diagnosis in case of fever. The risk of acquiring malaria depends on the length and intensity of exposure; the risk of developing severe disease is primarily determined by the health status of the traveler. These parameters need to be assessed before recommending chemoprophylaxis and/or stand-by emergency treatment. This review discusses the different strategies and drug options available for the prevention of malaria during and post travel.
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Affiliation(s)
- Blaise Genton
- Infectious Diseases, Department of Medicine, Travel Clinic Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland.
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García-Bujalance S, Francisco CNS, Rubio JM, Arribas JR, Gutierrez A. Imported Plasmodium falciparum malaria in HIV-infected patients: a report of two cases. Malar J 2012; 11:136. [PMID: 22540214 PMCID: PMC3358242 DOI: 10.1186/1475-2875-11-136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 04/27/2012] [Indexed: 11/11/2022] Open
Abstract
As HIV becomes a chronic infection, an increasing number of HIV-infected patients are travelling to malaria-endemic areas. Association of malaria with HIV/AIDS can be clinically severe. Severe falciparum malaria is a medical emergency that is associated with a high mortality, even when treated in an Intensive Care Unit. This article describes two cases of HIV-positive patients, who returned from malaria-endemic areas and presented a parasitaemia > 5% of erythrocytes and clinical signs of severe falciparum malaria, both with > 350 CD4 cell count/μl, absence of chemoprophylaxis and successful response. Factors like drug interactions and the possible implication of anti-malarial therapy bioavailability are all especially interesting in HIV-malaria co-infections.
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Affiliation(s)
- Silvia García-Bujalance
- Department of Microbiology and Parasitology, La Paz University Hospital-IdiPAZ, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Develoux M, Le Loup G, Dautheville S, Belkadi G, Magne D, Lassel L, Bonnard P, Pialoux G. [Malaria among immigrants, experience of a Parisian hospital (2006-2010)]. ACTA ACUST UNITED AC 2012; 105:95-102. [PMID: 22328065 DOI: 10.1007/s13149-012-0217-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 11/29/2011] [Indexed: 10/28/2022]
Abstract
In recent days immigrants represent the main risk group for imported malaria in northern countries. Most of them are migrants returning to their country of origin to visit friends and relatives (VFR). We retrospectively examined the main clinical, biological, and therapeutic data of all malaria cases in immigrants from 2006 to 2010 in Tenon hospital, Paris. The hospital is situated in a Paris district with an important African community. During the study period 239 imported malaria cases were observed in adults of which 199 were immigrants, 186 VFR, and 13 recently arrived. Most cases were from sub-Saharan Africa and Comoro islands. Chimioprophylaxis was not taken in 81.2% of VFR. It was inadequate in 43.7% and not taken correctly in 84.4%. Plasmodium falciparum was the most frequent species identified: 190/199 (95.5%). Severe P. falciparum malaria was observed in 25 cases (13.2%); two of them were recently arrived. One patient, African VFR, died. In this series two high-risk groups were represented: HIV-infected patients and pregnant women. Six of the HIV patients had severe malaria and all pregnant women had anemia. Our results are similar to those observed recently in other European countries. Mean age of VFR is increasing and the risk for severe P. falciparum malaria became identical to the one observed in non-immune travelers. Protection measures remain still insufficient in this population of travelers.
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Affiliation(s)
- M Develoux
- Hôpital Saint-Antoine, 182, rue du Faubourg-Saint-Antoine, F-75571 Paris Cedex 12, France.
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Antinori S, Cigardi B, Galimberti L, Orlando G, Schifanella L, Milazzo L, Viola A, Giuliani G, Ridolfo A, Corbellino M. Diagnosis and therapy for hospitalized imported malaria in adults in Italy. J Travel Med 2011; 18:379-85. [PMID: 22017713 DOI: 10.1111/j.1708-8305.2011.00554.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis and treatment of malaria in non-endemic countries presents a continuing challenge. METHODS Medical records were reviewed for 291 patients hospitalized with microscopically confirmed malaria diagnosed consecutively in two infectious diseases wards in Milano, Italy, between 1998 and 2007. RESULTS One hundred eighty-six (64%) were male; median age was 35 y (range 16-72 y). Of the 291 patients, 204 (70.1%) were non-immune travelers and 87 (29.9%) were considered semi-immune. In 228 patients (78.3%), Plasmodium falciparum was identified as the only causative malarial parasite. In 48 (16.5%), 9 (3.1%), and 1 (0.3%) cases, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae were diagnosed, respectively. Five mixed infections were observed (1.7%). Of the 233 falciparum cases (including mixed infections), 222 (95.3%) were acquired in sub-Saharan Africa. Fifty-four percent of P vivax infection were acquired in the Indian subcontinent and Southeast Asia. Chemoprophylaxis was used by 23.6% (61/258) subjects with only 32 fully compliant with the recommended regimen. At admission, fever, chills, and headache were present in 95.5, 59.5, and 55.3% of cases, respectively. Elevated serum lactate dehydrogenase levels (95%) and thrombocytopenia (82%) were the most frequently detected laboratory abnormalities. Thirty-five patients (15%) with P falciparum malaria presented with severe malaria according to the WHO criteria; in 19 patients (54.3%) more than one criteria was present. All patients recovered uneventfully. Inappropriate anti-malarial treatment occurred in 25 patients (8.6%) and were recorded more frequently among patients with a diagnosis of P vivax malaria (29.1%) as opposed to those affected by P falciparum (3.9%). CONCLUSIONS In our study more than two thirds of imported malaria cases were due to P falciparum with an excess of cases diagnosed in immigrants starting from the year 2000. Despite many available guidelines inappropriate initial malaria treatment is relatively frequent even when patients are managed in an infectious diseases ward.
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Affiliation(s)
- Spinello Antinori
- Department of Clinical Sciences L Sacco, Section of Infectious Diseases and Immunopathology, Università degli Studi di Milano, Milano, Italy.
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van Gool T, van Wolfswinkel ME, Koelewijn R, van Thiel PPAM, Jacobs J, van Hellemond JJ, van Genderen PJJ. A simple and fast method to exclude high Plasmodium falciparum parasitaemia in travellers with imported malaria. Malar J 2011; 10:300. [PMID: 21999570 PMCID: PMC3210116 DOI: 10.1186/1475-2875-10-300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 10/14/2011] [Indexed: 11/17/2022] Open
Abstract
Background Counts of malaria parasites in peripheral blood are important to assess severity of Plasmodium falciparum malaria. Thin and thick smears are routinely used for this purpose. Methods In this study the Binax NOW® Malaria Test, an easy-to-perform rapid diagnostic test, with Histidine Rich Protein-2 (HRP-2) and aldolase as diagnostic markers, was used for semi-quantitative assessment of parasitaemia of P. faciparum. Results In 257 patients with imported P. falciparum malaria, reactivity of aldolase increased with higher parasitaemia. In all patients with a parasitaemia above 50,000 asexual parasites/μl (> 1%) co-reactivity of HRP-2 and aldolase was observed. Absence of aldolase reactivity in the presence of HRP-2 was a reliable predictive marker to exclude high (> 1%) parasitaemia in P. falciparum malaria. Conclusions Assessment of HRP-2 and aldolase co-reactivity can be of help in clinical decision making in the acute care setting of returning travellers suspected of having malaria.
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Affiliation(s)
- Tom van Gool
- Department of Parasitology, Academic Medical Center, Amsterdam, The Netherlands.
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