Pediatric imported malaria in New York: Delayed diagnosis

The records of 20 children with imported malaria admitted to Kings County H ospital between October 1987 and May 1995 were reviewed. All had a history of recent travel or immigration from a malaria endemic area (West-Africa [1 6], Central-America [three], and the Caribbean [one]), None of the 10 child ren with a travel history received appropriate malaria chemoprophylaxis, Th e most common symptoms and signs were daily fever, chills, and hepatomegaly . Diagnosis was delayed in seven children who were initially felt to have p haryngitis or viral syndrome. Common laboratory findings were anemia and th rombocytopenia. P. falciparum was identified in 70% of the patients. Other species were P. malariae and P. vivax. Complications occurred in six childr en, hyponatremia. in five, seizures in three, and cerebral malaria in one p atient, The high incidence of chloroquine-resistant malaria makes chemoprop hylaxis difficult in children. The clinical presentation of malaria is nons pecific, and diagnostic delays occur, so a high index of suspicion is neede d in children with a travel history.