1459. Imported Malaria: Barriers to Prompt Diagnosis and Treatment from Four Hospitals in Connecticut
Session: Poster Abstract Session: Global Health
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • 41833_IDWPOSTER (1).pdf (701.5 kB)
  • Background: Globally, malaria (MAL) results in 3-5 x108 cases & 1.5-2.7 x106deaths/yr.  US cases are usually discovered serendipitously in returning travelers & immigrants from MAL endemic areas.  Consequently, the diagnosis (dx) and treatment (tx) of MAL in the US may be delayed.  We aim to identify barriers to the dx and tx of locally identified MAL cases from 4 community hospitals.

    Methods: Retrospective case series of patients with confirmed dx of MAL, 1995-2012.  A standardized case-report form was used to collect demographic & clinical data, & therapy details.

    Results: 23 patients dx with MAL: 11 African, 2 children of African immigrants, 4 Asians, & 2 with travel to Central/South America, [2 acquired MAL in the SE US]. 65% (13/20) were dx with P. falciparum, 15% (3/20) P. vivax, 5% (1/20) co-infected with both strains, 25% (5/20) P. malariae. Only 1 patient took antimalarial prophylaxis.   Symptoms (Sx) began on avg 3±2.6d(r=1-6) after arrival in the US.  Patients presented to the hospital 2.5d after onset of symptoms with P. falciparum; 37d for P. vivax.  For uninsured foreign individuals, time to seek care was 5.5d.  At presentation, MAL was on the Ddx in 65.2% of cases; travel history was obtained in 64.3% (9/14) of cases. Mean time to dx was 2.1±2d (r=0-6). Appropriate tx was initiated in 87% (14/16) of cases; mean time to tx was 1.4±1.2d (r=0-3).  Tx was timely in 50% of cases; 57% (4/7) of patients received therapy ≥8 hrs (mean=10.4±2.1h, r=7.5-12h) after it was ordered; delays occurred when hospitals were not stocked with medication.

    Conclusion: Imported MAL is rare but potentially fatal.   Prophylaxis is underutilized. Sx began soon after arrival & access to healthcare was a barrier for uninsured individuals. MAL dx was not entertained in a substantial portion of cases resulting in dx delays, particularly when the patient had multi-organ dysfunction. Rapid dxtic tests are lacking.  Tx was prescribed in nearly all cases; however, lack of availability of medication led to delayed tx.  It is important to refer symptomatic travelers from MAL endemic areas to healthcare facilities for rapid dx and tx.  Travelers must be educated about the importance of MAL prophylaxis; and hospitals must have a supply of MAL tx available at all times.

    Rassull Suarez, MD, Internal Medicine, Yale-New Haven Hospital, New Haven, CT, Chinedu Igwe, MD, Internal Medicine, Waterbury Hospital, Waterbury, CT, Nabeela Khan, MD, Griffin Hospital, Derby, CT; Internal Medicine, Griffin Hospital, Derby, CT, David Chia, MD, Yale Internal Medicine Residency Program, Waterbury, CT, Majid Sadigh, MD, Medicine, University of Vermont College of Medicine, Burlington, VT; Medicine, Western Connecticut Health Network, Brookfield, CT, Steven Aronin, MD, Infectious Diseases, Waterbury Hospital, Waterbury, CT and Michael Virata, MD, Infectious Diseases, Yale-New Haven Hospital-SRC, New Haven, CT; Yale University School of Medicine, New Haven, CT


    R. Suarez, None

    C. Igwe, None

    N. Khan, None

    D. Chia, None

    M. Sadigh, None

    S. Aronin, None

    M. Virata, None

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