Imported malaria in a non-endemic area: the experience of the university of Campinas hospital in the Brazilian Southeast

• Published in: Malaria journal Vol. 13; no. 1; p. 280
• Main Authors: Dos-Santos, João C K, Angerami, Rodrigo N, Castiñeiras, Catarina M S, Lopes, Stefanie C P, Albrecht, Letusa, Garcia, Márcia T, Levy, Carlos E, Moretti, Maria L, Lacerda, Marcus V G, Costa, Fabio T M
• Format: Journal Article
• Language: English
• Published: London BioMed Central 22.07.2014; BioMed Central Ltd
• Subjects: Acquired Immunodeficiency Syndrome - epidemiology; Adolescent; Adult; Anemia - etiology; Antimalarials - therapeutic use; Artemisinins - therapeutic use; Biomedical and Life Sciences; Biomedicine; Brazil - epidemiology; Care and treatment; Chloroquine - therapeutic use; Comorbidity; Data analysis; Development and progression; Drug dosages; Entomology; Epidemiology; Female; Follow-Up Studies; Health aspects; Hospitals; Humans; Infections; Infectious Diseases; Malaria; Malaria, Falciparum - blood; Malaria, Falciparum - complications; Malaria, Falciparum - drug therapy; Malaria, Falciparum - epidemiology; Malaria, Vivax - blood; Malaria, Vivax - complications; Malaria, Vivax - drug therapy; Malaria, Vivax - epidemiology; Male; Mefloquine - therapeutic use; Microbiology; Middle Aged; Parasitemia - epidemiology; Parasitemia - parasitology; Parasitology; Patient outcomes; Plasmodium falciparum; Plasmodium vivax; Primaquine - therapeutic use; Public Health; Recurrence; Retrospective Studies; Studies; Tertiary Care Centers - statistics & numerical data; Thrombocytopenia - etiology; Travel; Tropical diseases; Tropical Medicine; Young Adult; Brazil; Brazil, Amazon R; Brazil, Sao Paulo, Campinas; Brazil; Severity; Non-endemic area; Malaria; Epidemiology
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/1475-2875-13-280

Background Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. Methods A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Results Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Conclusions Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.