IMPORTED MALARIA - CLINICAL PRESENTATION AND EXAMINATION OF SYMPTOMATIC TRAVELERS

Background: The diagnosis of malaria in nonendemic countries presents a continuing challenge. Increasing physician awareness of the variabil ity in its clinical presentation will improve clinical management and health outcomes. Methods: Charts of patients in whom malaria was diagn osed at two hospital-based tropical disease centers between September 1, 1980, and December 31, 1991, were reviewed. Results: Of a total of 482 cases, 182 were caused by Plasmodium falciparum and 246 by Plasmod ium vivax. Fifty-two patients with P falciparum malaria were hospitali zed; 13 were classified as having severe falciparum malaria. Nineteen patients with P vivax malaria required hospitalization. The only death was caused by P vivax. Chemoprophylaxis was used by, or prescribed fo r, 46% of patients; however, of these, only half were compliant in tak ing their medication. Eighty-seven percent of patients with falciparum malaria presented within 6 weeks of return from travel to an endemic area. One third of patients with P vivax malaria presented more than 6 months after travel. The average time between onset of symptoms and p hysician contact was 6.7 days. Diagnosis was often delayed in those wh o sought care outside the referral center. Almost all patients had a h istory of fever, but only half were febrile at presentation. Presentin g symptoms and signs were nonspecific. Fifty percent of patients were thrombocytopenic. Other laboratory abnormalities were mild. Conclusion s: Since the presentation of malaria is vague and nonspecific, the dia gnosis should be considered in any appropriately symptomatic patient w ith a history of travel to a malaria-endemic area, and appropriate tes ting should be done. Up-to-date information on chemoprophylaxis should be provided to all travelers to malaria-endemic regions.