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Selimaj Kontoni V, Goetghebuer T, Hainaut M, Vanderfaeillie A, Nguyen VTP, Jourdain S, Pace D. Imported Malaria in Children: A Study Over an 11-Year Period in Brussels. Pediatr Infect Dis J 2023; 42:733-738. [PMID: 37406181 DOI: 10.1097/inf.0000000000003986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Malaria is a major global public health concern in endemic countries and imported childhood malaria is increasing in malaria non-endemic countries. METHODS This was a retrospective case review of all laboratory-confirmed malaria cases in children 0-16 years admitted between 2009 and 2019 in 2 large university teaching Hospitals in Brussels. RESULTS A total of 160 children with a median age of 6.8 years (range 5-191 months) were included. We identified 109 (68%) children living in Belgium who had acquired malaria during their visit to malaria-endemic countries to visiting friends and relatives (VFRs), 49 children (31%) visitors or newly installed migrants, and 2 Belgian tourists. Peak seasonal incidence occurred between August and September. Plasmodium falciparum was responsible for 89% of all malaria cases. Almost 80% of children living in Belgium visited a travel clinic for advice, but only one-third reported having taken the prophylaxis schedule according to the recommendations. Based on WHO criteria, 31 children (19.3%) developed severe malaria; most of the patients with severe malaria were VFR travelers and were significantly younger, had higher leukocytosis, had more thrombocytopenia, higher CRP, and lower natremia compared with patients with an uncomplicated course. All children recovered fully. CONCLUSIONS Malaria is a significant cause of morbidity among returning travelers and newly arrived immigrants to Belgium. Most of the children had an uncomplicated disease course. Physicians should educate families about traveling to malaria-endemic areas to correct malaria preventive measures and prophylaxis.
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Affiliation(s)
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Hainaut
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Vanderfaeillie
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Vo Thanh Phuong Nguyen
- Department of Pediatrics, Laboratoire d'Hematologie, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah Jourdain
- Department of Pediatrics, Hopital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - David Pace
- Department of Pediatrics, Mater Dei Hospital, Msida, Malta
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Sousa A, Silva TM, Conceição C, Vieira JP, Gouveia C, Varandas L. Cerebral Malaria and Cytotoxic Lesions of the Corpus Callosum. Pediatr Infect Dis J 2023; 42:e358-e359. [PMID: 37184269 DOI: 10.1097/inf.0000000000003963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Afonso Sousa
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefania Lisbon, Portugal
| | - Tiago Milheiro Silva
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefania Lisbon, Portugal
| | - Carla Conceição
- Neuroradiology Unit, Hospital Dona, Estefania. Lisbon, Portugal
| | | | - Catarina Gouveia
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefania. Lisbon, Portugal
- Nova Medical School, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Portugal
| | - Luís Varandas
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
- Department of Pediatrics, Hospital Dona Estefânia Lisbon, Portugal
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Pascua-Santamaría AE, Torrús-Tendero D, Mira-Perceval G, García-Galán P, Ramos-Rincón JM. Imported malaria in children in Alicante, Spain (1994-2019). Biomedica 2022; 42:244-252. [PMID: 35867918 PMCID: PMC9328780 DOI: 10.7705/biomedica.6068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
Abstract
Introduction: In recent years there has been an increase in imported malaria among children in whom it is a potentially serious and fatal disease. Objective: To describe the incidence and the clinical and epidemiological characteristics of malaria in children diagnosed in Alicante, Spain, over a 26-year period. Materials and methods: We conducted an observational retrospective study of malaria in children aged under 15 years diagnosed at the Alicante General University Hospital from 1994 to 2019. Results: Twenty-four cases were registered over the study period. The frequency of cases increased from 2 over the first five years to 11 in the last five years. The median age of the children was 6 years (interquartile range: 3-8); 91.6% came from sub-Saharan Africa. Over half (n=15, 62.5%) were children born in Spain to immigrant parents visiting friends and relatives (VFR); just one (6.7%) had received antimalarial chemoprophylaxis. The most frequent clinical signs were fever (86.9%), hepatosplenomegaly (70.8%), and anemia (70.8%). Plasmodium falciparum was the most frequently identified species (83.3%, n=20). The most common treatment was oral piperaquine/dihydroartemisinin (41.6%, n=10) with favorable outcomes in all cases. Conclusions: Imported childhood malaria shows an increasing incidence and a nonspecific clinical presentation. Professional awareness of this disease and a high degree of clinical suspicion are needed for the early initiation of treatment. Pre-travel preventive measures should be promoted when appropriate.
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Affiliation(s)
| | - Diego Torrús-Tendero
- Unidad de Referencia de Enfermedades Importadas y Salud Internacional, Hospital General Universitario de Alicante, Alicante, España; Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, España; Área de Parasitología, Universidad Miguel Hernández de Elche, Alicante, España.
| | - Gema Mira-Perceval
- Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España.
| | - Paloma García-Galán
- Servicio de Pediatría, Hospital Marina Baixa, Villajoyosa, Alicante, España.
| | - José Manuel Ramos-Rincón
- Unidad de Referencia de Enfermedades Importadas y Salud Internacional, Hospital General Universitario de Alicante, Alicante, España; Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España; Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Alicante, España.
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Bélard S, Brand J, Schulze-Sturm U, Janda A, von Both U, Tacoli C, Alberer M, Kempf C, Stegemann MS, Krüger R, Varnholt V, Blohm M, Reiter K, Zoller T, Suttorp N, Mall M, von Bernuth H, Gratopp A, Hübner J, Hufnagel M, Kobbe R, Kurth F. Intravenous Artesunate for Imported Severe Malaria in Children Treated in Four Tertiary Care Centers in Germany: A Retrospective Study. Pediatr Infect Dis J 2019; 38:e295-300. [PMID: 31626041 DOI: 10.1097/INF.0000000000002417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany. METHODS Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical; Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria. RESULTS Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria; 1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1-10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2-4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated. CONCLUSIONS ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.
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Lucchi NW, Ndiaye D, Britton S, Udhayakumar V. Expanding the malaria molecular diagnostic options: opportunities and challenges for loop-mediated isothermal amplification tests for malaria control and elimination. Expert Rev Mol Diagn 2018; 18:195-203. [DOI: 10.1080/14737159.2018.1431529] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Naomi W. Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daouda Ndiaye
- Laboratory of Parasitology and Mycology, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Sumudu Britton
- Department of Clinical Tropical Medicine, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
Background German surveillance data showed a sharp rise of malaria cases in 2014 and 2015 due to the increased arrival of refugees from malaria endemic countries. A time series analysis of data from 2001 to 2016 was performed in order to describe the epidemiology of imported malaria in Germany in general and of the recent increase in particular. Results In total, 11,678 malaria cases were notified between 2001 and 2016 (range 526–1063 cases/year). Newly arriving refugees averaged 10 cases/year (1.5%) in 2001–13 and 292.5 cases/year (28.3%) in 2014–15. Plasmodium (P.) falciparum was the most frequently reported species (range 57.2–85.8%), followed by P. vivax (range during 2001–2013: 7.6–18.1%; during 2014–2015, mean 31.3%). In 2014–15, 22.3% of all P. vivax cases were refugees from Eritrea and 3.3% from other countries of the Horn of Africa; in 2015 and 2016, 19.5% were refugees from Afghanistan and Pakistan. Five P. knowlesi malaria infections were reportedly acquired in Thailand between 2012 and 2016. Total numbers of malaria notifications among native Germans and residents with migration background showed an increasing trend since 2007. Chemoprophylaxis use was reported for 24.3% (1695/6984) of cases and showed a declining trend. Native German cases took significantly more frequently chemoprophylaxis than cases with migration background (32.6% vs. 17.9%; p < 0.001). Discussion/conclusions The steep rise in vivax malaria notifications in 2014 and 2015 was mainly due to newly arriving refugees from Eritrea but also from other countries of the Horn of Africa and South Asia. Clinicians should include malaria in their differential diagnosis in case of a febrile illness in the respective population and consider vivax malaria even if arrival to Germany dates back several months. Over the past 10 years, malaria notifications among native Germans and residents with migration background showed an increasing trend. Use of chemoprophylaxis was insufficient in both groups and deteriorating. New strategies need to be found to increase compliance to chemoprophylaxis recommendations. The surveillance provides valuable data for epidemiological assessment of imported malaria in Germany.
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Affiliation(s)
- Sabine Vygen-Bonnet
- Unit of Gastrointestinal Infections, Zoonoses and Tropical Infections, Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestr. 10, 13353, Berlin, Germany.
| | - Klaus Stark
- Unit of Gastrointestinal Infections, Zoonoses and Tropical Infections, Department of Infectious Disease Epidemiology, Robert Koch-Institute, Seestr. 10, 13353, Berlin, Germany
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