Imported malaria at an inner-city hospital in the United States.

BACKGROUND

More than 1000 cases of malaria are reported to the Centers for Disease Control and Prevention each year among travelers or immigrants.

METHODS

Retrospective study of patients with malaria seen at Grady Memorial Hospital in Atlanta, Georgia, between October 1988 and September 2000.

RESULTS

One hundred twenty-six cases of malaria were diagnosed at Grady Memorial Hospital during the study period. Fourteen patients had seen a physician prior to coming to Grady Memorial Hospital, and in 71% the diagnosis was missed. Half had recently immigrated and half recently traveled to an endemic area, yet only 22% of travelers took prophylaxis. Plasmodium falciparum was the most commonly identified species (52.4%), followed by Plasmodium vivax (23.9%). Seventy-two patients (57.1%) required hospitalization. Presenting symptoms included fever (94%), chills (56%), nausea/vomiting (38%), headache (26%), and abdominal pain (26%). Most patients were diagnosed correctly on the day of admission (79%). Twelve patients (16.7%) had severe malaria, and their complications included severe anemia (9.7%), acute renal failure (4.2%), bleeding and/or disseminated intravascular coagulation (4.2%), shock (2.8%), seizures (2.8%), and hypoglycemia (2.8%). One patient died, and two pregnant women had premature deliveries. Median hospital stay was 3.9 days. One third of the hospitalized patients with P vivax failed to receive primaquine, and in 15% of patients with P falciparum, the treatment was considered to be inappropriate.

CONCLUSIONS

Although some patients with malaria have a benign course and a good outcome, many patients require hospitalization, and some have severe complications. Increased efforts are needed to educate travelers about the need for prophylaxis.