Imported malaria in children in Marseilles.

Imported malaria is frequently observed in pediatric practices within geogr aphical areas which have a migrant population. Material and methods. - All the pediatric malaria cases of a university chi ldren's hospital (Marseilles, southern France) had been studied retrospecti vely. The period of the study was from January 1987 to December 1997 Inclus ion criteria were based on clinical diagnosis criteria established by WHO. Results. - Three hundred and fifteen clinical cases were observed. Ninety-n ine percent were confirmed by blood smears. Eighty-six percent of the patie nts came from the archipelago of the Comoro Islands in the Indian Ocean. Tw enty percent were not given chemoprophylaxis, and 77% of the patients with chemoprophylaxis were not compliant. Fever (92%), splenomegaly (61%), vomit ing and/or diarrhea (50%) were frequently observed Neurological signs (23%) , especially headaches (15%), were noted. The causative species was Plasmod ium falciparum in 76%; coinfections with two species were observed in 98. H alofantrine was commonly used for therapy (64%), but relapses were noted wi th this drug. No death was observed during the study. Discussion. - Imported pediatric malaria is rare in France. Critical signs may lead to misdiagnosis when splenomegaly is not obvious, or when vomiting and/or diarrhea, cough or otitis occur Diagnosis relies on blood smears. C urative medications are chloroquine or halofantrine, with special attention to heart troubles. Mefloquine is rarely used in children. Quinine is reser ved for serious attacks. Concerning chimioprophylaxy, medical prescriptions should be adapted to the stay abroad, and patient compliance to medication s could be improved. (C) 1999 Elsevier; Paris.