BACKGROUND: Malaria is diagnosed in children in the United States despite availability of effective chemoprophylaxis. The features impacting the presentation of malaria diagnosed in a nonendemic setting are not well characterized in children. METHODS: A retrospective chart review was conducted of children with peripheral smear-confirmed malaria diagnosed from 1994 to 2007 at 4 tertiary referral hospitals in Houston, TX. RESULTS: Among 104 children with malaria, 43 were recent immigrants and 61 were travelers leaving the United States. Severe malaria accounted for 21 (20%) of episodes. Children residing in the United States accounted for 86% of those with severe malaria. Factors relating to malaria severity included vacation-related travel (P = 0.005), female gender (P = 0.02), birth in the United States (P = 0.043), short travel duration (P = 0.024), and short duration from return to presentation (P = 0.023). Children with severe malaria more often had a history of vomiting (P = 0.048) and presented with hepatomegaly (P = 0.008), heart murmur (P = 0.041), and higher parasitemia (P < 0.001) than those with uncomplicated malaria. Vacation-related travel (aOR 7.6; 95% CI 1.4–61.5), admission hemoglobin (aOR 0.6; 95% CI 0.4–0.8), and admission platelet count (aOR 1.0; 95% CI 1.0-1.0) remained significant risk factors for severity by multivariate analysis. Prophylaxis appropriate to region of travel was documented in only 8 of 47 children leaving the United States. CONCLUSIONS: Children diagnosed in Houston with severe malaria usually had traveled from the United States to malaria-endemic regions without benefit of appropriate prophylaxis. Malaria-related morbidity in nonendemic countries could potentially be reduced by optimizing adherence to prophylactic regimens.
BACKGROUND:Malaria is diagnosed in children in the United States despite availability of effective chemoprophylaxis. The features impacting the presentation of malaria diagnosed in a nonendemic setting are not well characterized in children. METHODS: A retrospective chart review was conducted of children with peripheral smear-confirmed malaria diagnosed from 1994 to 2007 at 4 tertiary referral hospitals in Houston, TX. RESULTS: Among 104 children with malaria, 43 were recent immigrants and 61 were travelers leaving the United States. Severe malaria accounted for 21 (20%) of episodes. Children residing in the United States accounted for 86% of those with severe malaria. Factors relating to malaria severity included vacation-related travel (P = 0.005), female gender (P = 0.02), birth in the United States (P = 0.043), short travel duration (P = 0.024), and short duration from return to presentation (P = 0.023). Children with severe malaria more often had a history of vomiting (P = 0.048) and presented with hepatomegaly (P = 0.008), heart murmur (P = 0.041), and higher parasitemia (P < 0.001) than those with uncomplicated malaria. Vacation-related travel (aOR 7.6; 95% CI 1.4–61.5), admission hemoglobin (aOR 0.6; 95% CI 0.4–0.8), and admission platelet count (aOR 1.0; 95% CI 1.0-1.0) remained significant risk factors for severity by multivariate analysis. Prophylaxis appropriate to region of travel was documented in only 8 of 47 children leaving the United States. CONCLUSIONS:Children diagnosed in Houston with severe malaria usually had traveled from the United States to malaria-endemic regions without benefit of appropriate prophylaxis. Malaria-related morbidity in nonendemic countries could potentially be reduced by optimizing adherence to prophylactic regimens.
Authors: Herbert J Schilthuis; Ingrid Goossens; Robert J Ligthelm; Sake J de Vlas; Corlien Varkevisser; Jan H Richardus Journal: Trop Med Int Health Date: 2007-08 Impact factor: 2.622
Authors: Julie Thwing; Jacek Skarbinski; Robert D Newman; Ann M Barber; Sonja Mali; Jacquelin M Roberts; Laurence Slutsker; Paul M Arguin Journal: MMWR Surveill Summ Date: 2007-06-08