IMPORTED PLASMODIUM-FALCIPARUM MALARIA IN REUNION ISLAND FROM 1993 TO1996 - EPIDEMIOLOGY AND CLINICAL ASPECTS OF SEVERE COMPLICATIONS

Located in the Indian ocean, Reunion island, a French overseas territo ry, is free of malaria since the 1960's. As malaria is still highly en demic in the neighbouring countries, imported cases are averaging 130 to 150 cases per year. From 1993 to 1996, about 483 cases of imported malaria were admitted in Reunion. Five severe complicated Plasmodium f alciparum malaria cases occurring in non-immune persons, required furt her treatment in the intensive care unit (age 40 +/- 8 years, duration : 14,8 +/- 7,4, SAPS: 21 +/- 10). Three patients died. As short-stay t ravellers, patients were contaminated in Madagascar (4) and in Malawi (II and presented with an associated pathology : alcohol and tobacco a buses (2 cases), AIDS (1 case). In all cases, chemoprophylaxis was eit her inadequate (chloroquine alone, 3 cases) or absent (2 cases) and th e diagnosis and the appropriate treatment were delayed. Moreover, pati ents were either self-treating themselves, or initially refused to be admitted Parasitemia was very high. Two patients died within an hour f ollowing their admission before diagnosis could be made and quinine tr eatment be initiated (rupture of the spleen, multiple organ failure). One patient died at day 7 (acute respiratory distress syndrome, renal failure). Two survived under respiratory assistance and hemodialysis a nd presented the usual intensive care complications (respiratory nosoc omial infection, acute cholecystitis). In Reunion island, imported P. falciparum still accounts for a high rate of morbidity and few fatalit ies, despite a sophisticated curative health system. Delay in diagnosi s and institution of an appropriate treatment is frequent in nonimmune persons who develop fever and non-specific symptoms. It markedly incr eases the risk of complications and death from falciparum malaria as w ell as morbidity cofactors. Emphasis must be placed on appropriate inf ormation of health personnel and travellers.