title: Clinical characteristics of imported malaria: An 11-year experience in a Serbian referral center.
abstract: BACKGROUND
  Due to intercontinental traffic, population migration trends, natural disasters, and climate change, imported malaria remains important to consider in a febrile returning traveler. This study aims to raise awareness about malaria and help European clinicians maintain a working knowledge of this disease by reviewing the most important clinical characteristics in a non-endemic setting.
  
  
  METHODS
  Using medical records, a retrospective study was performed on clinical and laboratory data in order to analyze 103 malaria cases managed at the Clinic for Infectious and Tropical Diseases in Belgrade, from 2000 to 2010. Descriptive statistics, Chi-squared test, Spearman's rank correlation, and analysis of variance were used.
  
  
  RESULTS
  Patients were predominantly male (89.3%) with a mean age of 46.66 ± 12.45 years, and most (98.06%) returned from Africa without having taken chemoprophylaxis (72.88%). Fever, arthralgia, myalgia, headache, vomiting, dark urine, and cough were common at presentation. Hepatosplenomegaly, jaundice, neurological and pulmonary findings, and thrombocytopenia were dominant findings on physical and laboratory examinations. Most (73.48%) were infected with P. falciparum. Few patients (17.55%) who were hyperparasitemic had significantly higher values of bilirubin and more frequent neurological complications. All patients were treated with artemisinin-based drug combinations regardless of Plasmodium species. Three (2.9%) patients succumbed to P. falciparum malaria.
  
  
  CONCLUSIONS
  We suggest a high index of suspicion of malaria be maintained when evaluating febrile patients returning from endemic regions, especially if thrombocytopenia and hemolysis are present. Hyperparasitemia, high bilirubin levels, and neurological symptoms are associated with severe malaria. The importance of adequate malaria chemoprophylaxis cannot be overstated.
authors.affiliation: Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia. poluga@eunet.rs.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Poluga
authors.forename: Ivana
authors.initials: I
authors.lastname: Milosevic
authors.forename: Jelena
authors.initials: J
authors.lastname: Jordovic
authors.forename: Zorica
authors.initials: Z
authors.lastname: Dakic
authors.forename: Lidija
authors.initials: L
authors.lastname: Lavadinovic
authors.forename: Goran
authors.initials: G
authors.lastname: Stevanovic
authors.forename: Branko
authors.initials: B
authors.lastname: Milosevic
authors.forename: Dorde
authors.initials: D
authors.lastname: Jevtovic
authors.forename: Milorad
authors.initials: M
authors.lastname: Pavlovic
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D005260:Female; D006782:Hospitals, Special; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055771:Serbia; D016019:Survival Analysis; D014195:Travel
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin