Clinical characteristics of imported malaria: An 11-year experience in a Serbian referral center

  • Jasmina Poluga Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Ivana Milosevic Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Jelena Jordovic Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Zorica Dakic Clinical Center of Serbia, Belgrade, Serbia
  • Lidija Lavadinovic Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Goran Stevanovic Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Branko Milosevic Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Dorde Jevtovic Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
  • Milorad Pavlovic Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
Keywords: malaria, clinical characteristics, parasitemia

Abstract

Introduction: Due to intercontinental traffic, population migration trends, natural disasters, and climate change, imported malaria remains important to consider in a febrile returning traveler. This study aims to raise awareness about malaria and help European clinicians maintain a working knowledge of this disease by reviewing the most important clinical characteristics in a non-endemic setting.

Methodology: Using medical records, a retrospective study was performed on clinical and laboratory data in order to analyze 103 malaria cases managed at the ClinicforInfectious and Tropical Diseases in Belgrade, from 2000 to 2010. Descriptive statistics, Chi-squared test, Spearman's rank correlation, and analysis of variance were used.

Results: Patients were predominantly male (89.3%) with a mean age of 46.66 ± 12.45 years, and most (98.06%) returned from Africa without having taken chemoprophylaxis (72.88%). Fever, arthralgia, myalgia, headache, vomiting, dark urine, and cough were common at presentation. Hepatosplenomegaly, jaundice, neurological and pulmonary findings, and thrombocytopenia were dominant findings on physical and laboratory examinations. Most (73.48%) were infected with P. falciparum. Few patients (17.55%) who were hyperparasitemic had significantly higher values of bilirubin and more frequent neurological complications. All patients were treated with artemisinin-based drug combinations regardless of Plasmodium species. Three (2.9%) patients succumbed to P. falciparum malaria.

Conclusion: We suggest a high index of suspicion of malaria be maintained when evaluating febrile patients returning from endemic regions, especially if thrombocytopenia and hemolysis are present. Hyperparasitemia, high bilirubin levels, and neurological symptoms are associated with severe malaria. The importance of adequate malaria chemoprophylaxis cannot be overstated.

Published
2016-08-02
How to Cite
1.
Poluga J, Milosevic I, Jordovic J, Dakic Z, Lavadinovic L, Stevanovic G, Milosevic B, Jevtovic D, Pavlovic M (2016) Clinical characteristics of imported malaria: An 11-year experience in a Serbian referral center. J Infect Dev Ctries 10:770-776. doi: 10.3855/jidc.6799
Section
Original Articles