Imported malaria in immigrants to Italy: a changing pattern observed in north eastern Italy.
BACKGROUND
Seventy percent of imported malaria cases in Italy occur in immigrants, generally with milder clinical presentation due to premunition acquired through repeated infections. Nevertheless, premunition could be progressively lost after a long period of nonexposure. We investigated the changing pattern of malaria in immigrants in two definite 5-year periods one decade apart.


METHODS
We retrospectively examined the main laboratory findings of all malaria cases observed in immigrants from 1990 to 1994 and from 2000 to 2004. We stratified patients by reason for traveling: subjects in Italy who traveled to visit friends and relatives (VFR) or new immigrants (NI).


RESULTS
Forty-eight cases of malaria in immigrants occurred from 1990 to 1994, while 161 were observed from 2000 to 2004. Patients admitted in the latter period had a significantly higher parasitemia (median 6,298 vs 3,360 trophozoites/microL, p= 0.028) and lower platelet count (median 96.5 vs 132 x 10(9)/L, p= 0.012) and hemoglobin (median 12.6 vs 13.4 g/dL, p= 0.049). While NI did not show any significant difference in the two study periods, in the VFR subgroup a higher parasitemia (median 8,845 vs 2,690 trophozoites/microL, p= 0.003) and lower platelet count (median 96 vs 131 x 10(9)/L, p= 0.034) were observed during the second period, during which three cases of severe malaria occurred in VFR. A longer stay in Italy was reported in VFR admitted during the second study period (median 8.3 vs 5.7 years).


CONCLUSIONS
We found a changing pattern of malaria presentation in immigrants over a decade. The most likely explanation is the longer average stay outside endemic countries and subsequent loss of premunition observed in the second cohort. Immigrants living in Italy for some time and traveling to VFR should no more be considered a low-risk group for severe malaria. Pretravel advice should be particularly targeted to this group.
Department of Infectious Diseases, University of Verona, Verona, Italy. martamasca@yahoo.it
Marta
M
Mascarello
Federico
F
Gobbi
Andrea
A
Angheben
Ercole
E
Concia
Stefania
S
Marocco
Mariella
M
Anselmi
Geraldo
G
Monteiro
Andrea
A
Rossanese
Zeno
Z
Bisoffi
D000328:Adult; D000354:Africa, Western; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000302:isolation & purification; D012189:Retrospective Studies; D014195:Travel; D055815:Young Adult