Malaria--the mime revisited: fifteen more years of experience at a New York City teaching hospital.

PURPOSE AND PATIENTS: A previous review of The New York Hospital experience with malaria during 1968 to 1975 summarized clinical and parasitologic features in 24 travelers and highlighted deficiencies in both chemoprophylaxis and diagnosis. To extend this original study, we describe 86 patients with malaria seen at the same hospital during the subsequent 15 years.

RESULTS: Eighty patients were infected with a single Plasmodium species, and 60% had Plasmodium falciparum infection primarily acquired in Africa. Eighty percent were symptomatic while in or within 1 month of departing the malarious region. All patients described a history of fever; however, 25% were afebrile at the initial hospital visit. A normal white blood cell count, thrombocytopenia, and an increased lactate dehydrogenase level were common laboratory results. Seventy-five percent of non-native travelers took either no or inadequate chemoprophylaxis. Malaria was not suspected in 16 of the 20 (80%) patients seen initially by local New York City physicians but was initially suspected and confirmed in 49 of 54 (91%) patients first seen at The New York Hospital.

CONCLUSION: In comparison to our 1968 to 1975 experience, these updated results indicate no improvement in either the use of appropriate chemoprophylaxis or the capacity to properly diagnose malaria in the community. Improvement is still clearly needed in both areas.