PEDIATRIC MALARIA IN HOUSTON, TEXAS

We retrospectively reviewed the medical records of all infants and chi ldren (< 18 years of age) with the discharge diagnosis of malaria who were admitted to the four major pediatric teaching hospitals in Housto n, Texas from January 1988 through December 1993. Thirty-four cases of pediatric malaria were identified in three newborns, 22 travelers, an d nine recent immigrants. The travel destination was West Africa in 68 %, Central America in 14%, India in 14%, and unknown in 4%. The locati on of the child's and parents' birthplace was available in 77% of the travel-related cases and in all cases the destination of travel was th e parents' country of origin. The peak incident of the travel-related cases was late summer and early January corresponding to return from s ummer or Christmas vacation. Sixteen (75%) of the 22 travel-related ca ses had received either no prophylaxis (12 of 22) or inadequate (4 of 22) chemoprophylaxis. Half of the patients who were given appropriate chemoprophylaxis admitted to poor compliance. The clinical presentatio n was usually nonspecific. Fever was the most common symptom (97%) and was paroxysmal in one-third. Splenomegaly was the most common physica l finding (68%). The malaria species identified included Plasmodium fa lciparum (56%), P. vivax (23%), P. malariae (3%), and unidentified (18 %). Moderate anemia (hemoglobin level = 7.0-10 g/dL) occurred in 38% a nd severe anemia (hemoglobin level < 7.0 g/dL) in 29%. Three patients required transfusion. There were no end-organ complications. In summar y, pediatric malaria in Houston was primarily seen in immigrants or ch ildren of immigrants who returned to their native country. Education a nd preventive strategies should target these families and should be pa st of the routine well child care of these children.