title: Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast.
abstract: BACKGROUND
  Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject.
  
  
  METHODS
  A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011.
  
  
  RESULTS
  Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections.
  
  
  CONCLUSIONS
  Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.
authors.forename: João C K
authors.initials: JC
authors.lastname: Dos-Santos
authors.forename: Rodrigo N
authors.initials: RN
authors.lastname: Angerami
authors.forename: Catarina M S
authors.initials: CM
authors.lastname: Castiñeiras
authors.forename: Stefanie C P
authors.initials: SC
authors.lastname: Lopes
authors.forename: Letusa
authors.initials: L
authors.lastname: Albrecht
authors.forename: Márcia T
authors.initials: MT
authors.lastname: Garcia
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Levy
authors.forename: Maria L
authors.initials: ML
authors.lastname: Moretti
authors.forename: Marcus V G
authors.initials: MV
authors.lastname: Lacerda
authors.affiliation: Departamento de Genética, Evolução e Bioagentes, Instituo de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil. fabiotmc72@gmail.com.
authors.forename: Fabio T M
authors.initials: FT
authors.lastname: Costa
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000209:etiology; D000962:Antimalarials / Q000627:therapeutic use; D000077549:Artemether; D037621:Artemisinins / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002738:Chloroquine / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D016780:Malaria, Vivax / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use; D008875:Middle Aged; D018512:Parasitemia / Q000453:epidemiology* / Q000469:parasitology; D011319:Primaquine / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013921:Thrombocytopenia / Q000209:etiology; D014195:Travel; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D002738:Chloroquine; D000077549:Artemether; D011319:Primaquine; D015767:Mefloquine