title: [The risk of malaria during travel, observations in the department of infectious diseases in Cracow from 1996 to 2010].
abstract: Actually in Poland malaria is not present as an endemic disease, but is one of the most common "imported" diseases. In its mild form it is an awkward illness with recurring fever, whereas the more severe form, which is caused by Plasmodium falciparum can be life-threatening.
  
  
  OBJECTIVE
  Epidemiological and clinical analysis on malaria-infected patients hospitalized in the Department of Infectious Diseases in Cracow from 1996 to 2010.
  
  
  METHODS
  Interview, physical examination, laboratory tests and usg of the abdomen were performed among all patients. Diagnosis was performed by malaria parasites detection in direct microscopic observation of thick and thin blood films. Patients were treated with antimalarial drugs according to parasites species and previously used prophylaxis.
  
  
  RESULTS
  33 people with malaria, 26 men (79%) and 7 women (21%), aged 24-71 years were hospitalized. Annually 1 to 4 patients were treated, but in year 2008 - 7 patients. 18 persons (54%) were travelling as a tourists to the endemic regions, including 15 persons on short trips (up to 1 month). 15 persons (46%) were involved in business-trips and missions with over 2 years stay. Most patients visited Africa (25 persons), 4 travelled to Oceania, 3 to Asia and 1 to South America. Only 3 patients (9%) used recommended antimalarial prophylaxis. Symptoms of malaria usually appeared a few days after returning to Poland, 1 woman presented the symptoms after 1 year, 4 patients were presenting the symptoms already in the tropics. 25 persons (76%) had malaria for the first time. Clinical symptoms among patients were: fever preceded by shivering (100%), sweating (94%), muscles and joints pain (84%), nausea and vomiting (24%), diarrhoea (12%), jaundice (12%), cough (6%), coma (6%), multiorgan failure (6%). 12 persons were diagnosed with hepatomegaly, 21 with splenomegaly, 9 with hemolytic anaemia, 18 with thrombocytopenia and 14 with elevation of liver enzymes. P. falciparum infection was proven in 15 patients (46%), P. vivax in 11 patients (33%), P. ovale in 1 patient (3%), mixed infection (P. falciparum and P. ovale) in 6 patients (18%). In the treatment of P. falciparum infection quinine with doxycycline (18 patients) or mefloquine (2 patients) were used, in other cases chloroquine with following primaquine. 32 patients recovered, 1 patient with cerebral malaria died.
  
  
  CONCLUSIONS
  Malaria was most commonly diagnosed among tourists staying for short period of time in an endemic area. Travelers did not use accurate antimalarial prophylaxis. Malaria must be excluded as a potential diagnosis among all fever suffering persons returning from the tropics.
authors.affiliation: Klinika Chorób Zakaźnych, Katedra Gastroenterologii, Hepatologii i Chorób Zakaźnych UJCM w Krakowie. now1090@gmail.com
authors.forename: Anna
authors.initials: A
authors.lastname: Kalinowska-Nowak
authors.forename: Monika
authors.initials: M
authors.lastname: Bociaga-Jasik
authors.forename: Maciej
authors.initials: M
authors.lastname: Leśniak
authors.forename: Tomasz
authors.initials: T
authors.lastname: Mach
authors.forename: Aleksander
authors.initials: A
authors.lastname: Garlicki
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D011044:Poland / Q000453:epidemiology; D014195:Travel / Q000706:statistics & numerical data*; D014329:Tropical Climate; D055815:Young Adult
chemical_list: D000962:Antimalarials