“
“Background. The diagnosis and treatment of malaria in non-endemic countries presents a continuing challenge. Methods. Medical records were reviewed for 291 patients hospitalized with microscopically confirmed malaria diagnosed consecutively in two infectious diseases wards in Milano, Italy, between 1998 and 2007. Results. One hundred eighty-six (64%) were male; median age was 35 y (range 16–72 y). Of the 291 patients, 204 (70.1%) were non-immune travelers and 87 (29.9%) were considered semi-immune. In 228 patients Smoothened Agonist solubility dmso (78.3%), Plasmodium falciparum was identified as the only causative malarial parasite.

In 48 (16.5%), 9 (3.1%), and 1 (0.3%) cases, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae were diagnosed, respectively. Five mixed infections were observed (1.7%). Of the 233 falciparum cases (including mixed infections), 222 (95.3%) were acquired in sub-Saharan Africa. Fifty-four percent of P vivax infection were acquired in the Indian subcontinent

and Southeast see more Asia. Chemoprophylaxis was used by 23.6% (61/258) subjects with only 32 fully compliant with the recommended regimen. At admission, fever, chills, and headache were present in 95.5, 59.5, and 55.3% of cases, respectively. Elevated serum lactate dehydrogenase levels (95%) and thrombocytopenia (82%) were the most frequently detected laboratory abnormalities. Thirty-five patients (15%) with P falciparum malaria presented with severe malaria according to the WHO criteria; in 19 patients (54.3%) more than one criteria was present. All patients

recovered uneventfully. Inappropriate anti-malarial treatment occurred in 25 patients (8.6%) and were recorded from more frequently among patients with a diagnosis of P vivax malaria (29.1%) as opposed to those affected by P falciparum (3.9%). Conclusions. In our study more than two thirds of imported malaria cases were due to P falciparum with an excess of cases diagnosed in immigrants starting from the year 2000. Despite many available guidelines inappropriate initial malaria treatment is relatively frequent even when patients are managed in an infectious diseases ward. The number of malaria cases reported in European Union Countries each year is between 10,000 and 12,000 (crude rate 2.3/100,000 population) with France, UK, Germany, and Italy reporting the majority1; approximately 1300–1500 cases per year are reported in the USA (CDC).2 Several studies have highlighted the clinical and epidemiological characteristics of imported malaria among travelers and immigrants and the problems related to delayed diagnosis, but only few data exist on the treatment of imported malaria.3–6 In fact, malaria treatment is becoming increasingly difficult due to widespread drug resistance of Plasmodium falciparum and the more recent emergence of chloroquine-resistant Plasmodium vivax7,8 together with possible drug-associated adverse events.