Methods: We conducted a retrospective review of 90 cases of malaria seen at a single urban university hospital during 2000-2016.
Results: Of the 90 cases, 77% were Plasmodium falciparum, 14% were either P.ovale or P.vivax, 1% was P.malariae, and the rest were mixed or unknown. Eighty-one patients had traveled to Africa, 4 to Asia, 4 to more than one continent, and 1 to Haiti. Mean age was 41, and 59% were male. The main presenting symptoms were fever (92%), chills (78%), and headache (66%); 10% presented with cerebral malaria. Thirteen cases were managed as outpatients, 59 on a medical ward, and 18 in the ICU. Fourteen (16%) had severe malaria; these were more likely to present with hypotension, non-segmented neutrophilia, hyponatremia, metabolic acidosis, and acute kidney injury (all p<0.01). Thrombocytopenia was more severe in patients with severe malaria (54,000 v. 113,000, p<0.01). Treatment included quinine-based therapy (38%), atovaquone/proguanil (31%), artemether/lumefantrine (19%), and chloroquine/primaquine (11%). Twenty (22%) required change of treatment regimen due to inadequate clinical response or adverse effects. The most common in-hospital complications were ARDS (8%), QT prolongation (7%), and nosocomial infection (4%). Two patients were pregnant at the time of presentation; one suffered severe malaria and fetal loss. Only 3% of patients reported being prescribed a prophylactic regimen and completing it; 20% reported taking an incomplete course, and the majority took no prophylaxis at all. Of 27 patients who had presented to another US-based medical provider prior to hospitalization, 11 were initially misdiagnosed and treated for conditions other than malaria, including 2 who underwent extensive hematologic investigations. Inadequate experience and resources in treating malaria were the primary reasons cited for transfer to the tertiary hospital from community-based providers.
Conclusion: Malaria poses a substantial health risk to US travelers, particularly in light of under-utilization of prophylaxis, lack of familiarity with the disease by local providers, and delays to diagnosis.
D. Parenti, None
G. Simon, None