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IMPORTED PLASMODIUM FALCIPARUM MALARIA: ARE PATIENTS ORIGINATING FROM DISEASE-ENDEMIC AREAS LESS LIKELY TO DEVELOP SEVERE DISEASE? A PROSPECTIVE, OBSERVATIONAL STUDY

Just more than 2,000 cases of Plasmodium falciparum malaria are reported in the United Kingdom annually, with a mortality rate of approximately 1%. Some studies suggest that patients with malaria who originate from disease-endemic areas are less likely to develop severe disease; such patients are often treated at home. We have prospectively examined 99 patients with imported P. falciparum malaria and categorized them according to severity as defined by World Health Organization criteria. There was no significant difference between those who developed severe disease and those who did not in terms of their ethnicity, residence in a malaria-endemic area, or history of previous episodes of malaria. To assume a patient has clinical immunity to malaria simply because they originate from or have lived for a long time in a malaria-endemic area may be inappropriate and unsafe.

Received May 24, 2006. Accepted for publication August 2, 2006.

Acknowledgments: We are grateful to the following clinicians for recruiting patients to this study: Kazeem Aderogba, Jim Buckley, Alex Bunn, Anna Checkley, Rod Escombe, Matthew Hamill, Damien Hatton, Damien Mack, Fabiola Martin, Elinor Moore, Baz Nadjm, Richard Stümpfle, Sonali Sudarshi, and Jenny Whetham. We thank Professor Peter Chiodini and laboratory staff in the Department of Parasitology at the Hospital for Tropical Diseases for processing blood samples and examining malaria blood films. We are also grateful to Liz King for performing the cytokine assays and to Suzanna MacDonald for assisting with these assays.

Financial support: This study was supported by the Special Trustees of the Hospital for Tropical Diseases.

^* Address correspondence to Justin F. Doherty, Hospital for Tropical Diseases, Mortimer Market, Capper Street, London WC1E 6AU, United Kingdom. E-mail: tom.doherty{at}uclh.org

Authors’ addresses: Richard M. Jennings, Margaret Armstrong, and Katie L. Flanagan, Hospital for Tropical Diseases, Mortimer Market, Capper Street, London WC1E 6AU, United Kingdom. J. Brian de Souza, Jim E. Todd, and Eleanor M. Riley, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Justin F. Doherty, Hospital for Tropical Diseases, Mortimer Market, Capper Street, London WC1E 6AU, United Kingdom and London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.

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