ABSTRACT
Objective:
Cases with imported malaria have increased complication and mortality rates because of delayed diagnosis and treatment in non-endemic countries. This study aimed to investigate the incidence and clinical features of imported malaria in our clinic during the past 10 years.
Methods:
This retrospective study included 75 cases diagnosed as having imported malaria in our clinic between January 2008 and December 2017. The epidemiological data, laboratory findings, treatment data and clinical course of the cases were obtained from system records.
Results:
Patients were predominantly male (%98.6) with a median age of 51 (23-64) years. All cases were infected with Plasmodium falciparum, had a recent travel history to Sub-Saharan African countries and none had received chemoprophylaxis before travel. The incidence of imported malaria showed a declining trend after 2015. The most common findings were fever (100%), thrombocytopenia (84%) and anemia (72%). Although 8% of patients had presented with severe malaria, none of them died.
Conclusion:
Despite increasing incidence of imported malaria in our country in recent years, there is a decrease in this number in our region. Since Turkey is one of the countries with the highest prevalence of imported malaria in the world, patients with fever and thrombocytopenia should be questioned whether or not they had a history of travel to malaria-endemic area.
Keywords:
Hatay, imported malaria, Plasmodium falciparum, thrombocytopenia
References
1Fairhurst RM, Wellems TE. Malaria (Plasmodium Species). In: Bennet JE, Dolin R, Blaser MJ (eds). Mandell, Douglas and Bennett’s Principles and Practice of Infectious Disease. 8th ed. Philadelphia: Churchill Livingstone Elsevier; 2105.p.3437-62.
2Gething PW, Patil AP, Smith DL, Guerra CA, Elyazar IR, Johnston GL, et al. A new world malaria map: Plasmodium falciparum endemicity in 2010. Malar J 2011;10:378.
3World Health Organization. World Malaria Report. Geneva: World Health Organization;2017.
4World Health Organization. World Malaria Report. Geneva: World Health Organization;2012.
5Tatem A, Jia P, Ordanovich D, Falkner M, Huang Z, Howes R, et al. The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics. Lancet Infect Dis 2017;17:98-107.
6Checkley AM, Smith A, Smith V, Blaze M, Bradley D, Chiodini PL, et al. Risk factors for mortality from imported falciparum malaria in the United Kingdom over 20 years: an observational study. BMJ 2012;344:e2116.
7Andriopoulos P, Economopoulou A, Spanakos G, Assimakopoulos G. A local outbreak of autochthonous Plasmodium vivax malaria in Laconia, Greece--a re-emerging infection in the southern borders of Europe? Int J Infect Dis 2013;17:e125-8.
8Sağmak Tartar A, Akbulut A. Epidemiological, Clinical, and Laboratory Evaluation of Plasmodium falciparum Malaria Cases Followed in Firat University Hospital: A 6-Year Retrospective Analysis. Turkiye Parazitol Derg 2018;42:1-5.
9Önlen Y, Culha G, Ocak S, Savaş L, Güllü M. [Falciparum malaria originating in foreign country: four cases]. Turkiye Parazitol Derg 2007;31:256-9.
10WHO Guidelines for the treatment of malaria. Third edition. 2015.
11Berrevoets MA, Sprong T, Meis JF, Dofferhoff AS. Plasmodium falciparum malaria recrudescence occurring 2.5 years after leaving an endemic country. Neth J Med 2013;71:426-8.
12Arends JE, Oosterheert JJ, Kraaij-Dirkzwager MM, Kaan JA, Fanoy EB, Haas PJ, et al. Two cases of Plasmodium falciparum malaria in the Netherlands without recent travel to a malaria-endemic country. Am J Trop Med Hyg 2013;89:527-30.
13Szmitko PE, Kohn ML, Simor AE. Plasmodium falciparum malaria occurring 8 years after leaving an endemic area. Diagn Microbiol Infect Dis 2009;63:105-7.
14Al Hammadi A, Mitchell M, Abraham GM, Wang JP. Recrudescence of Plasmodium falciparum in a Primigravida After Nearly 3 Years of Latency. Am J Trop Med Hyg 2017;96:642-44.
15Ashley EA, Pyae Phyo A, Woodrow CJ. Malaria. Lancet. 2018 Apr 21;391:1608-21.
16Christen D, Steffen R, Schlagenhauf P. Deaths caused by malaria in Switzerland 1988-2002. Am J Trop Med Hyg 2006;75:1188-94.
17D’Acremont V, Landry P, Mueller I, Pécoud A, Genton B. Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travelers with fever. Am J Trop Med Hyg 2002;66:481-6.
18Lacerda MV, Mourão MP, Alexandre MA, Siqueira AM, Magalhães BM, Martinez-Espinosa FE, et al. Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature. Malar J 2012;11:12.
19World Health Organization. Severe Malaria. Trop Med Int Health 2014;19:7-131.
20Lampah DA, Yeo TW, Malloy M, Kenangalem E, Douglas NM, Ronaldo D, et al. Severe malarial thrombocytopenia: a risk factor for mortality in Papua, Indonesia. J Infect Dis 2015;211:623-34.
21Moses O, Nnodim Johnkennedy. The alteration of serum glucose, urea and creatinine level of malaria patients in Obowo Local Government Area of Imo State Nigeria. Int J Adv Med 2013;1:1-6
22Abdul Manan J, Ali H, Lal M. Acute renal failure associated with malaria. J Ayub Med Coll Abbottabad 2006;18:47-52.
23Mundhe R, Karale MS, Usendi C, Yadav S. Clinical profile and outcome of severe P. Falsiparum malaria. Int J Adv Med 2016;3:1034-38.
24Raminez JH, Porras B, Borrero E, Martinez SP. Factors associated with the severity and complication of patients with malaria hospitalized between 2009 and 2013 in three municipalities of Colombia, case control study. Malar J 2016;15:514.
25Anand AC, Puri P. Jaundice in malaria. J Gastroenterol Hepatol 2005;20:1322-32.
26Asma UE, Taufiq F, Khan W. Prevalence and clinical manifestations of malaria in Aligarh, India. Korean J Parasitol 2014;52:621-9.
