Clinical experience of 17 cases of imported malaria at a Taiwan university hospital, 1999-2005.
OBJECTIVE
Malaria had been eradicated in Taiwan since 1965, but there are currently 30 to 50 imported cases annually. The management of imported malaria continues to be challenging due to evolving drug resistance of Plasmodium parasites.


METHODS
We retrospectively analyzed the clinical presentations, treatment, and outcomes of all 16 adult patients (17 episodes) with imported malaria diagnosed during 1999-2005. The clinical and laboratory features were obtained from the medical records.


RESULTS
Malaria was acquired in sub-Saharan Africa in 6 cases and Southeast Asia in 11 cases. The initial presentations were nonspecific, including fever (17/17 cases), headache (11/17), nausea, vomiting or diarrhea (10/17), cough (3/17), thrombocytopenia (15/17), mild hyperbilirubinemia (13/17), leukopenia (6/17) and anemia (4/17). Careful travel history led to the correct diagnosis in 16 of 17 cases. All 17 cases survived without any recrudescence. Four cases presented with hyperparasitaemia (>5%). Two patients were admitted to an intensive care unit for complicated malaria, and both were cured by artesunate plus mefloquine. Some suboptimal practices, such as non-standard therapeutic regimen and lack of daily parasitemia counting were noted.


CONCLUSIONS
A differential diagnosis of malaria should be made in all patients who have fever after travel to any endemic area. To further improve the management of imported malaria, timely consultation of an experienced infectious disease specialist is necessary.
Chung
Hsing Chun
HC
Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Wang
Jann Tay
JT
Sun
Hsin Yun
HY
Wang
Jiun Ling
JL
Lo
Yi Chun
YC
Sheng
Wang Huei
WH
Hsieh
Szu Min
SM
Fang
Chi Tai
CT
Hsueh
Po Ren
PR
Chen
Yee Chun
YC
Chang
Shan Chwen
SC
D000328:Adult; D000368:Aged; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan
D000962:Antimalarials