Management of imported malaria in Europe
Open Access
- 17 September 2012
- journal article
- review article
- Published by Springer Science and Business Media LLC in Malaria Journal
- Vol. 11 (1), 1-15
- https://doi.org/10.1186/1475-2875-11-328
Abstract
In this position paper, the European Society for Clinical Microbiology and Infectious Diseases, Study Group on Clinical Parasitology, summarizes main issues regarding the management of imported malaria cases. Malaria is a rare diagnosis in Europe, but it is a medical emergency. A travel history is the key to suspecting malaria and is mandatory in patients with fever. There are no specific clinical signs or symptoms of malaria although fever is seen in almost all non-immune patients. Migrants from malaria endemic areas may have few symptoms. Malaria diagnostics should be performed immediately on suspicion of malaria and the gold- standard is microscopy of Giemsa-stained thick and thin blood films. A Rapid Diagnostic Test (RDT) may be used as an initial screening tool, but does not replace urgent microscopy which should be done in parallel. Delays in microscopy, however, should not lead to delayed initiation of appropriate treatment. Patients diagnosed with malaria should usually be hospitalized. If outpatient management is preferred, as is the practice in some European centres, patients must usually be followed closely (at least daily) until clinical and parasitological cure. Treatment of uncomplicated Plasmodium falciparum malaria is either with oral artemisinin combination therapy (ACT) or with the combination atovaquone/proguanil. Two forms of ACT are available in Europe: artemether/lumefantrine and dihydroartemisinin/piperaquine. ACT is also effective against Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi, but these species can be treated with chloroquine. Treatment of persistent liver forms in P. vivax and P. ovale with primaquine is indicated after excluding glucose 6 phosphate dehydrogenase deficiency. There are modified schedules and drug options for the treatment of malaria in special patient groups, such as children and pregnant women. The potential for drug interactions and the role of food in the absorption of anti-malarials are important considerations in the choice of treatment. Complicated malaria is treated with intravenous artesunate resulting in a much more rapid decrease in parasite density compared to quinine. Patients treated with intravenous artesunate should be closely monitored for haemolysis for four weeks after treatment. There is a concern in some countries about the lack of artesunate produced according to Good Manufacturing Practice (GMP).Keywords
This publication has 118 references indexed in Scilit:
- Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based studyThe Lancet Infectious Diseases, 2012
- Global malaria mortality between 1980 and 2010: a systematic analysisThe Lancet, 2012
- Malaria impairs resistance to Salmonella through heme- and heme oxygenase–dependent dysfunctional granulocyte mobilizationNature Medicine, 2011
- Mortality after Fluid Bolus in African Children with Severe InfectionThe New England Journal of Medicine, 2011
- Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trialThe Lancet, 2010
- Community-acquired bloodstream infections in Africa: a systematic review and meta-analysisThe Lancet Infectious Diseases, 2010
- Invasive Non‐TyphiSalmonellaDisease in AfricaClinical Infectious Diseases, 2009
- Plasmodium falciparum malaria occurring 8 years after leaving an endemic areaDiagnostic Microbiology and Infectious Disease, 2009
- Recovery of Endothelial Function in Severe Falciparum Malaria: Relationship with Improvement in Plasmal‐Arginine and Blood Lactate ConcentrationsThe Journal of Infectious Diseases, 2008
- Blood Coagulation, Inflammation, and MalariaMicrocirculation, 2008