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Selective ambulatory management of imported falciparum malaria: a 5-year prospective study

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Abstract

The ambulatory management of imported Plasmodium falciparum malaria is controversial because criteria for safe selection of patients are imprecise. The aim of the present study was to investigate the evolution and outcome of patients diagnosed with Plasmodium falciparum malaria at a Belgian referral institute in order to assess the safety of the institute’s current selective ambulatory management protocol. From 2000 to 2005, all patients diagnosed with P. falciparum infection at the Institute of Tropical Medicine and the University Hospital of Antwerp were enrolled prospectively. Ambulatory treatment was offered to nonvomiting patients if they exhibited none of the 2000 World Health Organization criteria of severity and had parasitemia below 1% at the initial assessment. The treatment of choice was quinine (plus doxycycline or clindamycin) for inpatients and atovaquone-proguanil for outpatients. P. falciparum malaria was diagnosed in 387 patients, of whom 246 (64%) were Western travelers or expatriates and 117 (30%) were already on antimalarial therapy. At diagnosis, 60 (15%) patients had severe malaria. Vital organ dysfunction was initially seen in 34 and developed later in five others. Five patients died. Of the 327 patients initially assessed as having uncomplicated malaria, 113 (35%) were admitted immediately; of these, 4 developed parasitemia ≥5% at a later stage but without any clinical consequence. None of the 214 individuals initially treated as outpatients experienced any malaria-related complications, including 10 who were admitted later. Vital organ dysfunction was observed in only 2 of the 214 patients with initial parasitemia <1% who had not taken antimalarial agents (both patients had impaired consciousness at presentation). Ambulatory treatment is safe in treatment-naive malaria patients with parasitemia <1% who do not vomit and who do not exhibit any criteria of severe malaria.

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References

  1. Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, Keystone JS, Pandey P, Cetron MS, GeoSentinel Surveillance Network (2006) Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med 354:119–130

    Article  PubMed  CAS  Google Scholar 

  2. Leder K, Black J, O’Brien D, Greenwood Z, Kain KC, Schwartz E, Brown G, Torresi J (2004) Malaria in travelers: a review of the GeoSentinel Surveillance Network. Clin Infect Dis 39:1104–1112

    Article  PubMed  Google Scholar 

  3. Eliades MJ, Shah S, Nguyen-Dinh P, Newman RD, Barber AM, Nguyen-Dinh P, Roberts JM, Mali S, Parise ME, Barber AM, Steketee R (2005) Malaria surveillance-United States, 2003. MMWR Surveill Summ 54:25–40

    PubMed  Google Scholar 

  4. Jelinek T, Schulte C, Behrens R, Grobusch MP, Coulaud JP, Bisoffi Z, Matteelli A, Clerinx J, Corachan M, Puente S, Gjorup I, Harms G et al (2002) Imported falciparum malaria in Europe: sentinel surveillance data from the European Network on Surveillance of Imported Infectious Diseases. Clin Infect Dis 34:572–576

    Article  PubMed  CAS  Google Scholar 

  5. Newman RD, Parise ME, Barber AM, Steketee RW (2004) Malaria-related deaths among U.S. travelers, 1963–2001. Ann Intern Med 141:547–555

    PubMed  Google Scholar 

  6. World Health Organization (1990) Severe and complicated malaria. Trans R Soc Trop Med Hyg 84(Suppl):S1–S65

    Article  Google Scholar 

  7. World Health Organization (2000) Severe falciparum malaria. Trans R Soc Trop Med Hyg 94(Suppl):S1–S90

    Article  Google Scholar 

  8. Bruneel F, Hocqueloux L, Alberti C, Wolff M, Chevret S, Bedos JP, Durand R, Le Bras J, Regnier B, Vachon F (2003) The clinical spectrum of severe imported falciparum malaria in the intensive care unit: report of 188 cases in adults. Am J Respir Crit Care Med 167:684–689

    Article  PubMed  Google Scholar 

  9. Moore DA, Jennings RM, Doherty TF, Lockwood DN, Chiodini PL, Wright SG, Whitty CJ (2003) Assessing the severity of malaria. BMJ 326:808–809

    Article  PubMed  Google Scholar 

  10. Molyneux M, Fox R (1993) Diagnosis and treatment of malaria in Britain. BMJ 306:1175–1180

    Article  PubMed  CAS  Google Scholar 

  11. D’Acremont V, Landry P, Darioli R, Stuerchler D, Pecoud A, Genton B (2002) Treatment of imported malaria in an ambulatory setting: prospective study. BMJ 324:875–876

    Article  PubMed  Google Scholar 

  12. Svenson JE, MacLean JD, Gyorkos TW, Keystone J (1995) Imported malaria. Clinical presentation and examination of symptomatic travelers. Arch Intern Med 155:861–868

    Article  PubMed  CAS  Google Scholar 

  13. Whitty CJ, Lockwood DN (2002) Commentary: should patients with imported malaria routinely be admitted? BMJ 324:875–876

    Article  Google Scholar 

  14. Marx A, Pewsner D, Egger M, Nuesch R, Bucher HC, Genton B, Hatz C, Juni P (2005) Meta-analysis: accuracy of rapid tests for malaria in travelers returning from endemic areas. Ann Intern Med 142:836–846

    PubMed  Google Scholar 

  15. Dondorp AM, Chau TT, Phu NH, Mai NT, Loc PP, Chuong LV, Sinh DX, Taylor A, Hien TT, White NJ, Day NP (2004) Unidentified acids of strong prognostic significance in severe malaria. Crit Care Med 32:1683–1688

    Article  PubMed  CAS  Google Scholar 

  16. van Genderen PJ, van der Meer I, Consten J, Petit PL, van Gool T, Overbosch D (2005) Evaluation of plasma lactate as a parameter for disease severity on admission in travelers with Plasmodium falciparum malaria. J Travel Med 12:261–264

    Article  PubMed  Google Scholar 

  17. Nguyen PH, Day N, Pram TD, Ferguson DJ, White NJ (1995) Intraleucocytic malaria pigment and prognosis in severe malaria. Trans R Soc Trop Med Hyg 89:200–204

    Article  PubMed  CAS  Google Scholar 

  18. Kain KC, Harrington MA, Tennyson S, Keystone JS (1998) Imported malaria: prospective analysis of problems in diagnosis and management. Clin Infect Dis 27:142–149

    PubMed  CAS  Google Scholar 

  19. Kain KC, MacPherson DW, Kelton T, Keystone JS, Mendelson J, MacLean JD (2001) Malaria deaths in visitors to Canada and in Canadian travellers: a case series. CMAJ 164:654–659

    PubMed  CAS  Google Scholar 

  20. Jensenius M, Ronning EJ, Blystad H, Bjorneklett A, Hellum KB, Bucher A, Haheim LL, Myrvang B (1999) Low frequency of complications in imported falciparum malaria: a review of 222 cases in south-eastern Norway. Scand J Infect Dis 31:73–78

    Article  PubMed  CAS  Google Scholar 

  21. Matteelli A, Colombini P, Gulletta M, Castelli F, Carosi G (1999) Epidemiological features and case management practices of imported malaria in northern Italy, 1991–1995. Trop Med Int Health 4:653–657

    Article  PubMed  CAS  Google Scholar 

  22. Imbert P, Gerardin P, Rogier C, Ka AS, Jouvencel P, Brousse V, Guyon P (2002) Severe falciparum malaria in children: a comparative study of 1990 and 2000 WHO criteria for clinical presentation, prognosis and intensive care in Dakar, Senegal. Trans R Soc Trop Med Hyg 96:278–281

    Article  PubMed  CAS  Google Scholar 

  23. Greenberg AE, Lobel HO (1990) Mortality from Plasmodium falciparum malaria in travelers from the United States, 1959 to 1987. Ann Intern Med 113:326–327

    PubMed  CAS  Google Scholar 

  24. Bouchaud O, Cot M, Kony S, Durand R, Schiemann R, Ralaimazava P, Coulaud JP, Le Bras J, Deloron P (2005) Do African immigrants living in France have long-term malarial immunity? Am J Trop Med Hyg 72:21–25

    PubMed  Google Scholar 

  25. Dondorp AM, Desakorn V, Pongtavornpinyo W, Sahassananda D, Silamut K, Chotivanich K, Newton PN, Pitisuttithum P, Smithyman AM, White NJ, Day NP (2005) Estimation of the total parasite biomass in acute falciparum malaria from plasma PfHRP2. PLoS Med 2:e204

    Article  PubMed  CAS  Google Scholar 

  26. Van Vugt M, Leonardi E, Phaipun L, Slight T, Thway KL, McGready R, Brockman A, Villegas L, Looareesuwan S, White NJ, Nosten F (2002) Treatment of uncomplicated multidrug-resistant falciparum malaria with artesunate-atovaquone-proguanil. Clin Infect Dis 35:1498–1504

    Article  PubMed  Google Scholar 

  27. Wichmann O, Muehlberger N, Jelinek T, Alifrangis M, Peyerl-Hoffmann G, Muhlen M, Grobusch MP, Gascon J, Matteelli A, Laferl H, Bisoffi Z, Ehrhardt S, Cuadros J, Hatz C, Gjorup I, McWhinney P, Beran J, da Cunha S, Schulze M, Kollaritsch H, Kern P, Fry G, Richter J; European Network on Surveillance of Imported Infectious Diseases (2004) Screening for mutations related to atovaquone/proguanil resistance in treatment failures and other imported isolates of Plasmodium falciparum in Europe. J Infect Dis 190:1541–1546

    Article  PubMed  CAS  Google Scholar 

  28. Dondorp A, Nosten F, Stepniewska K, Day N, White N (2005) Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet 366:717–725

    Article  PubMed  CAS  Google Scholar 

  29. Magill A, Panosian C (2005) Making antimalarial agents available in the United States. N Engl J Med 353:335–337

    Article  PubMed  CAS  Google Scholar 

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Bottieau, E., Clerinx, J., Colebunders, R. et al. Selective ambulatory management of imported falciparum malaria: a 5-year prospective study. Eur J Clin Microbiol Infect Dis 26, 181–188 (2007). https://doi.org/10.1007/s10096-007-0264-x

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