[Retrospective analysis of 107 imported adult cases of malaria. Experience report of uncomplicated falciparum malaria treatment in adults with oral atovaquone-proguanil].
OBJECTIVE
The principal aim of this study was to assess the efficacy of the combination of oral atovaquone and proguanil (AP) in routine treatment of uncomplicated falciparum malaria in recent visitors to the tropics. We also analyzed the epidemiologic, clinical and hematologic characteristics of these patients with imported malaria.


METHODS
This retrospective study reviewed the records of 107 cases of imported malaria, treated in the Tropical Disease Unit of Bordeaux University Hospital (France).


RESULTS
More than 75% had uncomplicated falciparum malaria; 10 developed complications, and one died. Average time from fever onset to first medical consultation was 4.8 days. Less than 10% had used physical measures of prevention against mosquito bites, and nearly 65% had not used chemoprophylaxis. The most frequent hematologic abnormalities were eosinopenia (84%) and thrombocytopenia (75%). In more than 30% of cases, another disease was also present. The oral AP combination was administered to more than 86% of patients with uncomplicated falciparum malaria (n=72). Tolerance was excellent and only one treatment failure was observed, associated with digestive disorders.


CONCLUSIONS
Better information for travelers and general practitioners is required to reduce the number of cases of imported malaria and to shorten the delay between symptom onset and specific treatment. The oral AP combination appears to be a safe and effective treatment for uncomplicated imported falciparum malaria.
Vatan
Rémy
R
Service de Médecine Interne et des Maladies Tropicales, Hôpital Saint-André, Bordeaux.
Pistone
Thierry
T
Millet
Pascal
P
Etienne
Gabriel
G
Mercié
Patrick
P
Longy-Boursier
Maïté
M
Malvy
Denis
D
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004338:Drug Combinations; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D002727:Proguanil / Q000008:administration & dosage / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000453:epidemiology; D014195:Travel
D000962:Antimalarials; D004338:Drug Combinations; D002727:Proguanil