Predictive factors of malaria in travelers to areas where malaria is endemic.
BACKGROUND
The differentiation of malaria from other causes of fever is difficult. The development of tools for rapid and specific clinical diagnosis is of paramount importance for the identification of individuals infected with malaria.


METHODS
A 4-year prospective study to identify the clinical and biological variables associated with malaria included all patients suspected of having malaria who presented in the emergency department (ED) of a French hospital.


RESULTS
Of 783 patients admitted to the ED with suspected malaria, 145 had positive findings of a thick smear for Plasmodium species, mainly Plasmodium falciparum (90.3%). In univariate analysis, the following 12 variables were significantly associated with diagnosis of malaria: older than 30 years, male sex, immigration to France from an area where malaria is endemic, a visit to sub-Saharan Africa, insufficient antimalaria prophylaxis, fever, chills, absence of diarrhea, a leukocyte count within the reference range, thrombocytopenia, and increased lactate dehydrogenase and bilirubin levels. In multivariate analysis, the factors predictive of malaria included a visit to sub-Saharan Africa (odds ratio [OR], 7.7; 95% confidence interval [CI], 2.8-21.3), a temperature of at least 38.5 degrees C (OR, 6.2; 95% CI, 2.8-13.3), chills (OR, 3.0; 95% CI, 1.4-6.6), thrombocytopenia (OR, 16.5; 95% CI, 7.1-38.3), and abnormally high total bilirubin levels (OR, 21.5; 95% CI, 6.4-72.5). However, alone or combined, these features had insufficient sensitivity (95.0%) and low specificity (55.0%) for the diagnosis of malaria.


CONCLUSIONS
Malaria should be suspected in all patients presenting with complaints after travel to an area where malaria is endemic, and these patients should undergo blood microscopy.
Emergency Department, Infectious and Tropical Diseases Unit A, Bichat-Claude Bernard University Hospital, Paris, France. enrique.casalino@bct.ap-hop-paris.fr
Enrique
E
Casalino
Jacques
J
Le Bras
Florence
F
Chaussin
Anika
A
Fichelle
Elisabeth
E
Bouvet
D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D019353:Endemic Diseases; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005602:France; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014195:Travel