Hospitalization criteria in imported falciparum malaria.
BACKGROUND
Controversy exists about the management of patients with imported Plasmodium falciparum malaria. We postulated that rapid parasite clearance supports ambulatory care, or, conversely, that factors associated with longer parasite clearance time (PCT) could be used as hospitalization criteria.


METHODS
Hospitalized patients with imported falciparum malaria recruited through one single travel clinic between 1993 and 2000. We used a linear regression to identify factors independently associated with PCT defined as the time in hours from antimalarial drug administration until the first negative malaria smear.


RESULTS
Among 400 patients hospitalized with falciparum malaria, mean (range) PCT was 58 (1-189) hours. In multivariate analysis, severe malaria, gastrointestinal signs, initial temperature greater than or equal to 40 degrees C, parasitemia greater than or equal to 1%, and platelet counts less than 50,000/microL were associated with longer PCT. Offering ambulatory care to patients aged 15 to 64 years with none of the factors associated with longer PCT in the study would have resulted in 147 (37%) patients receiving outpatient care.


CONCLUSIONS
Factors identified in this model may help physicians determine which P falciparum malaria patients can be treated on an ambulatory basis, and contribute to revisions of national guidelines for imported malaria management.
Briand
Valérie
V
Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France. vale.briand@laposte.net
Bouchaud
Olivier
O
Tourret
Jérôme
J
Behr
Charlotte
C
Abgrall
Sophie
S
Ralaimazava
Pascal
P
Le Bras
Jacques
J
Fontanet
Arnaud
A
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000962:Antimalarials / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D006301:Health Services Needs and Demand; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D021261:Parasitic Sensitivity Tests; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D018579:Patient Selection; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000962:Antimalarials