| Title | Epidemiologic Features Impacting the Presentation of Malaria in Children in Houston. | | Author(s) | Oramasionwu GE, Wootton SH, Edwards MS | | Institution | From the *Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX; and daggerDivision of Infectious Diseases, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX. | | Source | Pediatr Infect Dis J 2009 Oct 30. | | Abstract | BACKGROUND:: Malaria is diagnosed in children in the United States despite availability of effective chemoprophylaxis. The features impacting the presentation of malaria diagnosed in a nonendemic setting are not well characterized in children.
METHODS:: A retrospective chart review was conducted of children with peripheral smear-confirmed malaria diagnosed from 1994 to 2007 at 4 tertiary referral hospitals in Houston, TX.
RESULTS:: Among 104 children with malaria, 43 were recent immigrants and 61 were travelers leaving the United States. Severe malaria accounted for 21 (20%) of episodes. Children residing in the United States accounted for 86% of those with severe malaria. Factors relating to malaria severity included vacation-related travel (P = 0.005), female gender (P = 0.02), birth in the United States (P = 0.043), short travel duration (P = 0.024), and short duration from return to presentation (P = 0.023). Children with severe malaria more often had a history of vomiting (P = 0.048) and presented with hepatomegaly (P = 0.008), heart murmur (P = 0.041), and higher parasitemia (P < 0.001) than those with uncomplicated malaria. Vacation-related travel (OR: 19.7; 95% CI: 2.2-174.6) and hepatomegaly (OR: 6.1; 95% CI: 1.1-32.8) remained significant risk factors for severity by multivariate analysis. Prophylaxis appropriate to region of travel was documented in only 8 of 47 children leaving the United States.
CONCLUSIONS:: Children diagnosed in Houston with severe malaria usually had traveled from the United States to malaria-endemic regions without benefit of appropriate prophylaxis. Malaria-related morbidity in nonendemic countries could potentially be reduced by optimizing adherence to prophylactic regimens. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19884871 |
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