Julie Gutman1, Jeanette Guarner. 1. Department of Pediatric Infectious Disease, Emory University School of Medicine, Atlanta, GA 30322, USA. gutmanjr@gmail.com
Abstract
BACKGROUND: Although malaria is frequent in travelers, it is often misdiagnosed on initial presentation, especially in children. The objective of this study is to describe epidemiology, clinical and laboratory presentation, and treatment of children with malaria in the United States. METHODS: We performed a retrospective review of 50 confirmed cases of malaria from two pediatric metropolitan hospitals in Atlanta, GA, from 2000 to 2008. RESULTS: Malarial smears were performed in 385 unique patients; 50 (12.6%) were positive. American children who had visited family and friends in malaria-endemic countries comprised 62% of our cases. Most cases visited Nigeria or Cameroon; all but three traveled to Africa. Three patients presented 8 to 12 months following travel. Plasmodium falciparum was diagnosed most frequently (72%). Most patients had low-level parasitemia (<1%). Gametocytes were rarely identified. Treatment was primarily with quinine and either doxycycline or clindamycin, and transfusion was rare. All patients responded rapidly to treatment. Although seven (14%) had hyperparasitemia (> 5%), no fatalities or long-term sequelae were seen. CONCLUSIONS: Malarial diagnosis can be difficult in children because parasitemia is usually below 1%. A high index of suspicion is required in patients who have traveled to Africa.
BACKGROUND: Although malaria is frequent in travelers, it is often misdiagnosed on initial presentation, especially in children. The objective of this study is to describe epidemiology, clinical and laboratory presentation, and treatment of children with malaria in the United States. METHODS: We performed a retrospective review of 50 confirmed cases of malaria from two pediatric metropolitan hospitals in Atlanta, GA, from 2000 to 2008. RESULTS:Malarial smears were performed in 385 unique patients; 50 (12.6%) were positive. American children who had visited family and friends in malaria-endemic countries comprised 62% of our cases. Most cases visited Nigeria or Cameroon; all but three traveled to Africa. Three patients presented 8 to 12 months following travel. Plasmodium falciparum was diagnosed most frequently (72%). Most patients had low-level parasitemia (<1%). Gametocytes were rarely identified. Treatment was primarily with quinine and either doxycycline or clindamycin, and transfusion was rare. All patients responded rapidly to treatment. Although seven (14%) had hyperparasitemia (> 5%), no fatalities or long-term sequelae were seen. CONCLUSIONS:Malarial diagnosis can be difficult in children because parasitemia is usually below 1%. A high index of suspicion is required in patients who have traveled to Africa.