title: Epidemiologic features impacting the presentation of malaria in children in Houston.
abstract: Malaria is diagnosed in children in the United States despite availability of effective chemoprophylaxis. The features impacting the presentation of malaria diagnosed in a nonendemic setting are not well characterized in children.
  
  
  
  A retrospective chart review was conducted of children with peripheral smear-confirmed malaria diagnosed from 1994 to 2007 at 4 tertiary referral hospitals in Houston, TX.
  
  
  
  Among 104 children with malaria, 43 were recent immigrants and 61 were travelers leaving the United States. Severe malaria accounted for 21 (20%) of episodes. Children residing in the United States accounted for 86% of those with severe malaria. Factors relating to malaria severity included vacation-related travel (P = 0.005), female gender (P = 0.02), birth in the United States (P = 0.043), short travel duration (P = 0.024), and short duration from return to presentation (P = 0.023). Children with severe malaria more often had a history of vomiting (P = 0.048) and presented with hepatomegaly (P = 0.008), heart murmur (P = 0.041), and higher parasitemia (P < 0.001) than those with uncomplicated malaria. Vacation-related travel (aOR 7.6; 95% CI 1.4–61.5), admission hemoglobin (aOR 0.6; 95% CI 0.4–0.8), and admission platelet count (aOR 1.0; 95% CI 1.0-1.0) remained significant risk factors for severity by multivariate analysis. Prophylaxis appropriate to region of travel was documented in only 8 of 47 children leaving the United States.
  
  
  
  Children diagnosed in Houston with severe malaria usually had traveled from the United States to malaria-endemic regions without benefit of appropriate prophylaxis. Malaria-related morbidity in nonendemic countries could potentially be reduced by optimizing adherence to prophylactic regimens.
authors.affiliation: Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Gloria E
authors.initials: GE
authors.lastname: Oramasionwu
authors.forename: Susan H
authors.initials: SH
authors.lastname: Wootton
authors.forename: Morven S
authors.initials: MS
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000962:Antimalarials / Q000627:therapeutic use; D001769:Blood / Q000469:parasitology; D018890:Chemoprevention / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D008853:Microscopy / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014195:Travel
chemical_list: D000962:Antimalarials