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Malaria Slips Across the Border -- Are You Prepared?

Malaria eludes customs inspectors -- and many physicians in the U.S., as well

Malaria, which causes 1-3 million deaths annually, is the most important parasitic infection among humans. Its incidence is rising in developed countries because of increased international travel and immigration. Diagnosis of malaria in the U.S. is problematic, but what about treatment? Investigators recently reviewed all 88 malaria cases diagnosed between 1991 and 1999 at Cook County Hospital in Chicago.

Medical records were available for 83 patients. All had become infected while traveling or living in malaria-endemic areas (mostly in Africa or the Indian subcontinent), and very few had used chemoprophylaxis. Blood smears showed Plasmodium vivax in 46 patients (56%) and P. falciparum in 37 (45%); 2 patients (2%) were also infected with a second species. Sixty patients (72%) were hospitalized; patients infected with P. falciparum had a longer mean length of stay than did those infected with P. vivax.

Errors in antimalarial treatment were noted for 20 patients: 12 patients with P. vivax infection did not receive primaquine phosphate, 5 patients each with P. vivax or P. falciparum infection received an inappropriate regimen, and 2 misdiagnosed patients received no documented therapy. Additionally, 12 of 29 patients who were prescribed primaquine did not undergo G6PD testing, and 7 underwent unnecessary bone marrow biopsies because doctors failed to recognize the hematologic complications of malaria.

Comment: These findings show the importance of expertise in malaria and other diseases now on the rise in developed countries due to globalization. They also show the benefit of retrospective evaluations in identifying medical errors and thereby improving medical education and care.

— Linda M. Mundy, MD

Published in Journal Watch Infectious Diseases October 27, 2003

Citation(s):

Singh K et al. Problems in the therapy for imported malaria in the United States. Arch Intern Med 2003 Sep 22; 163:2027-30.

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