title: Malarial cases presenting to a European urban Emergency Department.
abstract: BACKGROUND
  Malaria accounts for approximately 225 million infections and 781 000 deaths annually worldwide. Malaria should be considered in the Emergency Department as an important cause of illness in returning travellers. We were interested in evaluating the malarial caseload presenting to an urban inner city Emergency Department in terms of the nature and severity of clinical presentations.
  
  
  METHODS
  A retrospective study of all cases of malaria presenting to our Emergency Department from 1 January 2004 to the 31 December 2010 was conducted. Information about patient demographics, areas in which malaria was contracted, clinical course, treatment and complications was recorded from chart reviews.
  
  
  RESULTS
  Fifty-six cases of malaria were diagnosed in the period studied. The majority of patients had falciparum malaria (80%), were originally from West or Central Africa (75%), were mainly from Nigeria (48%), and were visiting friends and relatives in their country of origin. A total of 79% had not taken appropriate antimalarial chemoprophylaxis. A total of 7% were classified as severe malaria according to the WHO criteria. There was one death.
  
  
  CONCLUSIONS
  Malarial cases occurred predominantly in immigrants who were returning to endemic areas to visit friends and relatives in their country of origin. The majority of patients did not undergo antimalarial prophylaxis. Severe malaria is a medical emergency requiring urgent recognition and appropriate antimicrobial and critical care therapy. Improving public awareness and healthcare promotion regarding risks of travel-related malaria may help to improve compliance with prophylaxis and preventative measures, and thereby reduce the prevalence of malarial infection in this group.
authors.affiliation: Emergency Department, St James's Hospital, Dublin, Ireland. tomasbreslin@mac.com
authors.forename: Tomás M
authors.initials: TM
authors.lastname: Breslin
authors.forename: Una Nic
authors.initials: UN
authors.lastname: Ionmhain
authors.forename: Colm
authors.initials: C
authors.lastname: Bergin
authors.forename: David
authors.initials: D
authors.lastname: Gallagher
authors.forename: Níamh
authors.initials: N
authors.lastname: Collins
authors.forename: Nora
authors.initials: N
authors.lastname: Kinsella
authors.forename: Geraldine
authors.initials: G
authors.lastname: McMahon
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000962:Antimalarials / Q000627:therapeutic use; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D017780:Malaria Vaccines / Q000008:administration & dosage*; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014195:Travel; D014505:Urban Population; D055815:Young Adult
chemical_list: D000962:Antimalarials; D017780:Malaria Vaccines