Volume 81, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2000. Severe falciparum malaria. Trans R Soc Trop Med Hyg 94 (Suppl 1): S1–S90. [Google Scholar]
  2. Jelinek T, Schulte C, Behrens R, Grobusch MP, Coulaud JP, Bisoffi Z, Matteelli A, Clerinx J, Corachan M, Puente S, Gjorup I, Harms G, Kollaritsch H, Kotlowski A, Bjorkmann A, Delmont JP, Knobloch J, Nielsen LN, Cuadros J, Hatz C, Beran J, Schmid ML, Schulze M, Lopez-Velez R, Fleischer K, Kapaun A, McWhinney P, Kern P, Atougia J, Fry G, da Cunha S, Boecken G, 2002. Imported falciparum malaria in Europe: sentinel surveillance data from the European network on surveillance of imported infectious diseases. Clin Infect Dis 34: 572–576. [Google Scholar]
  3. Christen D, Steffen R, Schlagenhauf P, 2006. Deaths caused by malaria in Switzerland, 1988–2002. Am J Trop Med Hyg 75: 1188–1194. [Google Scholar]
  4. Matteelli A, Colombini P, Gulletta M, Castelli F, Carosi G, 1999. Epidemiological features and case management practices of imported malaria in northern Italy, 1991–1995. Trop Med Int Health 4: 653–657. [Google Scholar]
  5. Spinazzola F, Nicastri E, Vlassi C, Ghirga P, De Marco M, Pittalis S, Paglia MG, Ferrari C, Narciso P, 2007. Imported malaria at Italy’s National Institute for Infectious Diseases Lazzaro Spallanzani, 1984–2003. Eur J Clin Microbiol Infect Dis 26: 175–179. [Google Scholar]
  6. Bruneel F, Hocqueloux L, Alberti C, Wolff M, Chevret S, Bedos JP, Durand R, Le BJ, Regnier B, Vachon F, 2003. The clinical spectrum of severe imported falciparum malaria in the intensive care unit: report of 188 cases in adults. Am J Respir Crit Care Med 167: 684–689. [Google Scholar]
  7. Corne P, Klouche K, Basset D, Amigues L, Beraud JJ, Jonquet O, 2004. Severe imported malaria in adults: a retrospective study of 32 cases admitted to intensive care units [in French]. Pathol Biol (Paris) 52: 622–626. [Google Scholar]
  8. Espinosa G, Tortajada C, Gascon J, Miquel R, Nicolas JM, Nadal P, Corachan M, 1997. Severe Plasmodium falciparum malaria. Description of 5 cases [in Spanish]. Rev Clin Esp 197: 631–634. [Google Scholar]
  9. World Health Organization, 1990. Severe and complicated malaria. Trans R Soc Trop Med Hyg 84 (Suppl 2): 1–65. [Google Scholar]
  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE, 1985. APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829. [Google Scholar]
  11. Salvado E, Pinazo MJ, Muñoz J, Alonso D, Mayor A, Quinto Ll, Gascon J, 2008. Clinical presentation and complications of falciparum malaria in two populations: travelers and immigrants [in Spanish]. Enferm Infecc Microbiol Clin 26: 282–284. [Google Scholar]
  12. Legros F, Bouchaud O, Ancelle T, Arnaud A, Cojean S, Le BJ, Danis M, Fontanet A, Durand R, 2007. Risk factors for imported fatal Plasmodium falciparum malaria, France, 1996–2003. Emerg Infect Dis 13: 883–888. [Google Scholar]
  13. Bouchaud O, Cot M, Kony S, Durand R, Schiemann R, Ralaimazava P, Coulaud JP, Le BJ, Deloron P, 2005. Do African immigrants living in France have long-term malarial immunity? Am J Trop Med Hyg 72: 21–25. [Google Scholar]
  14. Jennings RM, De Souza JB, Todd JE, Armstrong M, Flanagan KL, Riley EM, Doherty JF, 2006. Imported Plasmodium falciparum malaria: are patients originating from disease-endemic areas less likely to develop severe disease? A prospective, observational study. Am J Trop Med Hyg 75: 1195–1199. [Google Scholar]
  15. Muhlberger N, Jelinek T, Behrens RH, Gjorup I, Coulaud JP, Clerinx J, Puente S, Burchard G, Gascon J, Grobusch MP, Weitzel T, Zoller T, Kollaritsch H, Beran J, Iversen J, Hatz C, Schmid ML, Bjorkman A, Fleischer K, Bisoffi Z, Guggemos W, Knobloch J, Matteelli A, Schulze MH, Laferl H, Kapaun A, McWhinney P, Lopez-Velez R, Fatkenheuer G, Kern P, Zieger BW, Kotlowski A, Fry G, Cuadros J, Myrvang B, 2003. Age as a risk factor for severe manifestations and fatal outcome of falciparum malaria in European patients: observations from TropNetEurop and SIMPID Surveillance Data. Clin Infect Dis 36: 990–995. [Google Scholar]
  16. Centers for Disease Control and Prevention, 2007. Health Information for International Travel 2008. Atlanta: US Department of Health and Human Services, Public Health Service Atlanta.
  17. World Health Organization, 2007. International Travel and Health: Situation as on 1 January 2007. Geneva: World Health Organization.
  18. World Health Organization, 2006. Guidelines for the Treatment of Malaria. Geneva: World Health Organization.
  19. Jones KL, Donegan S, Lalloo DG, 2007. Artesunate versus quinine for treating severe malaria. Cochrane Database Syst Rev CD005967. [Google Scholar]
  20. Lalloo DG, Shingadia D, Pasvol G, Chiodini PL, Whitty CJ, Beeching NJ, Hill DR, Warrell DA, Bannister BA, 2007. UK malaria treatment guidelines. J Infect 54: 111–121. [Google Scholar]
  21. Jelinek T, 2005. Intravenous artesunate recommended for patients with severe malaria: position statement from TropNetEurop. Euro Surveill 10: E051124. [Google Scholar]
  22. Riddle MS, Jackson JL, Sanders JW, Blazes DL, 2002. Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a meta-analysis. Clin Infect Dis 34: 1192–1198. [Google Scholar]

Data & Media loading...

  • Received : 09 Dec 2008
  • Accepted : 08 Jul 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error