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Volume 40, Number 3, June 2007

Clinical experience of 17 cases of imported malaria at a Taiwan university hospital, 1999-2005


Hsing-Chun Chung, Jann-Tay Wang, Hsin-Yun Sun, Jiun-Ling Wang, Yi-Chun Lo, Wang-Huei Sheng, Szu-Min Hsieh, Chi-Tai Fang, Po-Ren Hsueh, Yee-Chun Chen, Shan-Chwen Chang
Division of Infectious Diseases, Department of Internal Medicine, and Departments of Medical Research and Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan

Received: April 6, 2006    Revised: July 30, 2006    Accepted: August 1, 2006   

 

Corresponding author:

Dr. Shan-Chwen Chang, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail: changsc@ntu.edu.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

Malaria had been eradicated in Taiwan since 1965, but there are currently 30 to 50 imported cases annually. The management of imported malaria continues to be challenging due to evolving drug resistance of Plasmodium parasites.
 



 

Methods:

We retrospectively analyzed the clinical presentations, treatment, and outcomes of all 16 adult patients (17 episodes) with imported malaria diagnosed during 1999-2005. The clinical and laboratory features were obtained from the medical records.

 



 

Results:

Malaria was acquired in sub-Saharan Africa in 6 cases and Southeast Asia in 11 cases. The initial presentations were nonspecific, including fever (17/17 cases), headache (11/17), nausea, vomiting or diarrhea (10/17), cough (3/17), thrombocytopenia (15/17), mild hyperbilirubinemia (13/17), leukopenia (6/17) and anemia (4/17). Careful travel history led to the correct diagnosis in 16 of 17 cases. All 17 cases survived without any recrudescence. Four cases presented with hyperparasitaemia (>5%). Two patients were admitted to an intensive care unit for complicated malaria, and both were cured by artesunate plus mefloquine. Some suboptimal practices, such as non-standard therapeutic regimen and lack of daily parasitemia counting were noted.
 



 

Conclusion:

A differential diagnosis of malaria should be made in all patients who have fever after travel to any endemic area. To further improve the management of imported malaria, timely consultation of an experienced infectious disease specialist is necessary.

 



 

Key words:

Artesunate; Combination drug therapy; Malaria; Plasmodium falciparum; Plasmodium vivax



 

J Microbiol Immunol Infect. 2007;40:209-215.