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CLINICAL CHARACTERISTICS OF IMPORTED MALARIA IN JAPAN: ANALYSIS AT A REFERRAL HOSPITAL

Imported malaria remains an important problem in Japan. We have reviewed the medical records of 170 cases of malaria in our hospital, which corresponds to 14.9% of the total cases in Japan. The predominant malarial species was Plasmodium falciparum (52.3%), and the most frequent area of acquisition was Africa (54.2%), followed by Asia (20.9%) and Oceania (19.6%). The most common reason for travel among Japanese patients was business. A significant proportion (22.2%) of vivax malaria cases experienced relapse despite standard primaquine therapy. Most primaquine failures were from Oceania. We also found that a substantial number of Japanese patients contracted malaria without chemoprophylaxis and consulted medical facilities with an unfavorably long delay from initial symptoms (median: 3.0 days). Direct education of travelers and travel companies, in addition to health care providers, is likely necessary to improve outcomes of imported malaria.

Received August 18, 2004. Accepted for publication March 20, 2005.

Acknowledgments: The authors thank Dr. Jay Keystone (Division of Infectious Diseases, Department of Medicine, University of Toronto) for his advice for the treatment of primaquine-resistant vivax malaria. We also thank Dr. Philip Peters (Division of Infectious Diseases, Emory University) for reviewing the language of the manuscript.

Financial support: This work was sponsored by the research grant for "Research on Health Sciences Focusing on Drug Innovation" from the Japan Health Sciences Foundation and Health and Labor Science Research Grants from the Ministry of Health, Labor and Welfare in Japan.

^* Address correspondence to Tetsuya Nakamura, Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai Minato-ku, Tokyo 108-8639, Japan. E-mail: tnakamur{at}ims.u-tokyo.ac.jp

Authors’ addresses: Toshiyuki Miura, Tokiomi Endo, Hitomi Nakamura, Takashi Odawara, and Aikichi Iwamoto, Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai Minato-ku, Tokyo 108-8639 Japan, Telephone: +81-3-5449-5338, Fax: +81-3-5449-5427. Tomohiko Koibuchi and Tetsuya Nakamura, Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai Minato-ku, Tokyo 108-8639, Japan, Telephone: +81-3-5449-5338, Fax: +81-3-5449-5427. Mikio Kimura, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama Shinjuku-ku, Tokyo 162-8640, Japan, Telephone: +81-3-5285-1111, Fax: +81-3-5285-1129. Yusuke Wataya, Department of Drug Informatics, Faculty of Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Okayama 700-8530, Japan, Telephone: +81-86-251-7976, Fax: +81-86-251-7974.

Reprint requests: Tetsuya Nakamura, Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan, Telephone: +81-3-5449-5338, Fax: +81-3-5449-5427, E-mail: tnakamur{at}ims.u-tokyo.ac.jp.