BACKGROUND: Controversy exists about the management of patients with imported Plasmodium falciparum malaria. We postulated that rapid parasite clearance supports ambulatory care, or, conversely, that factors associated with longer parasite clearance time (PCT) could be used as hospitalization criteria. METHODS: Hospitalized patients with imported falciparum malaria recruited through one single travel clinic between 1993 and 2000. We used a linear regression to identify factors independently associated with PCT defined as the time in hours from antimalarial drug administration until the first negative malaria smear. RESULTS: Among 400 patients hospitalized with falciparum malaria, mean (range) PCT was 58 (1-189) hours. In multivariate analysis, severe malaria, gastrointestinal signs, initial temperature greater than or equal to 40 degrees C, parasitemia greater than or equal to 1%, and platelet counts less than 50,000/microL were associated with longer PCT. Offering ambulatory care to patients aged 15 to 64 years with none of the factors associated with longer PCT in the study would have resulted in 147 (37%) patients receiving outpatient care. CONCLUSION: Factors identified in this model may help physicians determine which P falciparum malaria patients can be treated on an ambulatory basis, and contribute to revisions of national guidelines for imported malaria management.
BACKGROUND: Controversy exists about the management of patients with imported Plasmodium falciparum malaria. We postulated that rapid parasite clearance supports ambulatory care, or, conversely, that factors associated with longer parasite clearance time (PCT) could be used as hospitalization criteria. METHODS: Hospitalized patients with imported falciparum malaria recruited through one single travel clinic between 1993 and 2000. We used a linear regression to identify factors independently associated with PCT defined as the time in hours from antimalarial drug administration until the first negative malaria smear. RESULTS: Among 400 patients hospitalized with falciparum malaria, mean (range) PCT was 58 (1-189) hours. In multivariate analysis, severe malaria, gastrointestinal signs, initial temperature greater than or equal to 40 degrees C, parasitemia greater than or equal to 1%, and platelet counts less than 50,000/microL were associated with longer PCT. Offering ambulatory care to patients aged 15 to 64 years with none of the factors associated with longer PCT in the study would have resulted in 147 (37%) patients receiving outpatient care. CONCLUSION: Factors identified in this model may help physicians determine which P falciparum malariapatients can be treated on an ambulatory basis, and contribute to revisions of national guidelines for imported malaria management.
Authors: Olivier Bouchaud; Nikolai Mühlberger; Philippe Parola; Guido Calleri; Alberto Matteelli; Gabriele Peyerl-Hoffmann; Frédéric Méchaï; Philippe Gautret; Jan Clerinx; Peter G Kremsner; Tomas Jelinek; Annette Kaiser; Anna Beltrame; Matthias L Schmid; Peter Kern; Meike Probst; Alessandro Bartoloni; Thomas Weinke; Martin P Grobusch Journal: Malar J Date: 2012-06-22 Impact factor: 2.979