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Diagnosis and therapy for hospitalized imported malaria in adults in Italy.
J Travel Med. 2011 Nov-Dec; 18(6):379-85.JT

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.

Authors+Show Affiliations

Department of Clinical Sciences L Sacco, Section of Infectious Diseases and Immunopathology, Università degli Studi di Milano, Milano, Italy. spinello.antinori@unimi.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22017713

Citation

Antinori, Spinello, et al. "Diagnosis and Therapy for Hospitalized Imported Malaria in Adults in Italy." Journal of Travel Medicine, vol. 18, no. 6, 2011, pp. 379-85.
Antinori S, Cigardi B, Galimberti L, et al. Diagnosis and therapy for hospitalized imported malaria in adults in Italy. J Travel Med. 2011;18(6):379-85.
Antinori, S., Cigardi, B., Galimberti, L., Orlando, G., Schifanella, L., Milazzo, L., Viola, A., Giuliani, G., Ridolfo, A., & Corbellino, M. (2011). Diagnosis and therapy for hospitalized imported malaria in adults in Italy. Journal of Travel Medicine, 18(6), 379-85. https://doi.org/10.1111/j.1708-8305.2011.00554.x
Antinori S, et al. Diagnosis and Therapy for Hospitalized Imported Malaria in Adults in Italy. J Travel Med. 2011 Nov-Dec;18(6):379-85. PubMed PMID: 22017713.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and therapy for hospitalized imported malaria in adults in Italy. AU - Antinori,Spinello, AU - Cigardi,Barbara, AU - Galimberti,Laura, AU - Orlando,Giovanna, AU - Schifanella,Luca, AU - Milazzo,Laura, AU - Viola,Anita, AU - Giuliani,Giuseppe, AU - Ridolfo,Annalisa, AU - Corbellino,Mario, Y1 - 2011/10/17/ PY - 2011/10/25/entrez PY - 2011/10/25/pubmed PY - 2012/3/1/medline SP - 379 EP - 85 JF - Journal of travel medicine JO - J Travel Med VL - 18 IS - 6 N2 - 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. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/22017713/Diagnosis_and_therapy_for_hospitalized_imported_malaria_in_adults_in_Italy_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1111/j.1708-8305.2011.00554.x DB - PRIME DP - Unbound Medicine ER -