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Am. J. Trop. Med. Hyg., 81(4), 2009, pp. 595-599
doi:10.4269/ajtmh.2009.08-0637;
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Severe Imported Malaria in Adults: Retrospective Study of 20 Cases

Ana González*, Josep M. Nicolás, Jose Muñoz, Pedro Castro, Jordi Mas, Ma Eugenia Valls, Josep R. Coma, Jesús Aibar, AND Joaquim Gascon
Barcelona Centre for International Health Research, CRESIB, CIBERESP, Hospital Clinic, Barcelona, Spain; Intensive Care Unit and Parasitology Unit, Hospital Clínic, Barcelona, Spain

Severe imported malaria is an important problem in many countries in which this disease is not endemic. This retrospective study describes the characteristics of 20 adults with severe imported malaria admitted to our intensive care unit from 1991 through 2007. All episodes were caused by Plasmodium falciparum and all patients had returned from sub-Saharan Africa, except for one transfusion recipient. All persons were considered non-immune, and none had taken appropriate chemoprophylaxis. The median time between the initiation of symptoms and the diagnosis was seven days. Five patients died (mortality rate = 25%). A higher frequency of unrousable coma and acidosis and a higher median Apache II score at admission was noted in the persons who died. Mortality by severe malaria remains high despite high quality management, which highlights the importance of chemoprophylaxis and early diagnosis and treatment.

Received December 9, 2008. Accepted for publication July 8, 2009.

Acknowledgments: We thank Donna Pringle for suggestions and English language review of the manuscript. This study was presented in part at the Sixth Congress of the Tropical Medicine and International Health Spanish Society, March 5–7, 2008, Segovia, Spain (Abstract PC56). This abstract is available from Enf. Emerg 2008; 10:45.

* Address correspondence to Ana González, Centre for International Health Research, c/Rosselló 132, 4°, 08036 Barcelona, Spain. E-mail: portana1{at}gmail.com

Authors’ addresses: Ana González, Jose Muñoz, and Joaquim Gascon, Centre for International Health Research, c/Rosselló 132, 4°, 08036 Barcelona, Spain, E-mail: portana1{at}gmail.com. Josep M. Nicolás, Pedro Castro, Josep R. Coma, and Jesús Aibar, Intensive Care Unit, Hospital Clínic, c/Villarroel 170, 08036 Barcelona, Spain, E-mail: nicolas{at}clinic.ub.es. Jordi Mas and Ma Eugenia Valls, Parasitology Unit, Microbiology Department, Hospital Clinic, c/Villarroel 170, 08036 Barcelona, Spain, E-mails: jmas{at}clinic.ub.es and mevalls{at}clinic.ub.es.

Reprint requests: Ana González, Centre for International Health Research, c/Rosselló 132, 4°, 08036 Barcelona, Spain, E-mail: portana1{at}gmail.com.




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