Severe imported Plasmodium falciparum malaria, France, 1996-2003

Little is known about severe imported Plasmodium falciparum malaria in industrialized countries where the disease is not endemic because most studies have been case reports or have included <200 patients. To identify factors independently associated with the severity of P. falciparum, we conducted a retrospective study using surveillance data obtained from 21,888 P. falciparum patients in France during 1996-2003; 832 were classified as having severe malaria. The global case-fatality rate was 0.4% and the rate of severe malaria was ≈3.8%. Factors independently associated with severe imported P. falciparum malaria were older age, European origin, travel to eastern Africa, absence of chemoprophylaxis, initial visit to a general practitioner, time to diagnosis of 4 to 12 days, and diagnosis during the fall-winter season. Pretravel advice should take into account these factors and promote the use of antimalarial chemoprophylaxis for every traveler, with a particular focus on nonimmune travelers and elderly persons.     

Chemosusceptibility analysis of Plasmodium falciparum imported from Comoros to Marseilles, France in 2001-2003

OBJECTIVES: The aim of this work was to study the chemosensitivity of Plasmodium falciparum strains isolated from patients presenting with malaria after having returned from Comoros Islands in 2002-2003, and hospitalized at the North University Hospital, in Marseilles, France. MATERIALS AND METHODS: In vitro drug susceptibility (for strains maintained in culture) and mutation-specific polymerase chain reaction (PCR) assays (for all strains) were performed. RESULTS: Out of 23 strains kept in culture, 50% were shown to be resistant in vitro to chloroquine, 50% were resistant to pyrimethamine, 40% to cycloguanil, 25% to atovaquone, and 7% to mefloquine. However all these strains were susceptible to quinine, halofantrine, and artemether. Moreover, 48 strains were tested by molecular methods. As a result, 69% were shown to have the Asp108 mutation in the dihydrofolate reductase gene (Pfdhfr), the basic mutation associated with antifolate resistance, and 54% had additional mutations Ile51 plus Arg59, associated with a high level of resistance. Furthermore, 90% of the 20 strains tested in 2003 were shown to have the point mutation Pfcrt76 in the P. falciparum chloroquine resistance transporter (Pfcrt) gene recently proposed as a molecular marker of chloroquine-resistance. CONCLUSION: Obtaining plasmodium strains from Comoros to be tested in Marseilles, where all laboratory facilities are available, is a unique opportunity to establish a surveillance of falciparum drug resistance in the Comoros islands.     

Treatment of imported cases of falciparum malaria in France with halofantrine

Halofantrine is a 9-phenanthrenemethanol which is effective against multi-drug resistant strains of Plasmodium falciparum. It has been shown to be highly effective and extremely well tolerated in the treatment of imported cases of falciparum malaria in France. A total of 1,500 mg administered in three 500 mg doses at six-hour intervals results in a 100% cure rate in semi-immune subjects. This dosage should be repeated after 14 days to obtain the same cure rate in non-immune patients. Minor clinical side effects included epigastric pains, nausea and, in one case, a skin rash.     

输入性恶性疟疾一例报道

沙洋县属于中华按蚊低疟区,以间日疟为主,属非恶性疟疾流行区.2005年疟疾发病2例,发病率为0.27/10万.2006年5月9 日,发生输入性恶性疟疾 1例,现将病例调查报道如下.     

2010-2012年徐州市输入性恶性疟流行病学分析

目的分析徐州市境外输入性恶性疟疫情,提出现阶段可行的预防和控制措施。方法对徐州市网络直报的恶性疟疫情和流行病学资料进行分析。结果徐州市2010-2012年发生输入性恶性疟共40例,分别为12、11、17例。病例均为男性,全年均有发病,发病分布在出国务工人员较多的县区,病例主要是出国劳务人员。40例恶性疟均为境外感染,临床表现为高热,发热时间不规则,部分患者有胃肠道症状;37例患者血片镜检疟原虫阳性。结论徐州市输入性恶性疟有增多趋势,应加强重点地区劳务输出归国人员的疟疾防治管理工作。     

Diagnosis of imported malaria in France

The need for diagnosis of imported malaria is frequent in France. Diagnosis biological tools are different, according methods, sensitivity, interpretation and costs. Strategies for their use could be stratified according locally available methods, and experience of the practician.     

Chloroquine-resistant falciparum malaria imported into the Netherlands

A prospective study of imported chloroquine-resistant falciparum malaria in the Netherlands is described. From 1979 to 1983, 77 non-immune patients were investigated; in 41 (53%) decreased sensitivity of Plasmodium falciparum to chloroquine could be confirmed. Signs and symptoms in these patients differ from the classical picture. Resistance to sulfadoxine—pyrimethamine (Fansidar) was established in 6 patients. Parasitaemia was found twice during dapsone—pyrimethamine (Maloprim) prophylaxis. The implications for advice on treatment and prophylaxis are discussed.     

Unusual transmission of Plasmodium falciparum, Bordeaux, France, 2009

Plasmodium falciparum malaria is usually transmitted by mosquitoes. We report 2 cases in France transmitted by other modes: occupational blood exposure and blood transfusion. Even where malaria is not endemic, it should be considered as a cause of unexplained acute fever.     

Plasmodium falciparum malaria and atovaquone-proguanil treatment failure

We noticed overrepresentation of atovaquone-proguanil therapeutic failures among Plasmodium falciparum-infected travelers weighing >100 kg. We report here 1 of these cases, which was not due to resistant parasites or impaired drug bioavailability. The follow-up of such patients should be strengthened.     

Defined Plasmodium falciparum antigens in malaria serology

The study evaluates three enzyme-linked immunosorbent assays (ELISA) of malaria antigens suitable for use in large-scale epidemiological studies. Results obtained using sera from 567 persons from the Gambia indicated that the micro-ELISA method using parasitized red blood cell extract did not reliably quantitate antimalarial antibodies, especially in young children. In contrast, two micro-ELISA methods that employed purified, defined antigens (a polypeptide of M_r = 41 000 present in rhoptries, and a 31-1 fusion polypeptide corresponding to a merozoite surface antigen) permitted the precise determination of antimalarial antibodies in both adults and children. Problems and advantages associated with the use of the M_r = 41 000 and 31-1 antigens for the determination of antimalarial antibodies are discussed.     

Chloroquine-resistant Plasmodium falciparum malaria in Kenya.

A case of chloroquine-resistant Plasmodium falciparum malaria in a non-immune male is reported. Primary attack came 19 days after return to a non-malarious country from a visit to Kenya. Recrudescences occurred three times with intervals of 30 to 33 days after standard chloroquine treatment. The WHO extended field test for sensitivity of falciparum malaria to chloroquine was followed by recrudescence 31 days later. Treatment with Fansidar terminated the infection. If continuous treatment of the patient with lithium does not interfere with the schizontocidal action of chloroquine, this strain shows a resistance pattern of R I delayed recrudescence.     

Plasmodium falciparum malaria in an asplenic man

An asplenic man with no prior exposure to malaria was infected with Plasmodium falciparum on a visit to Kenya. The peripheral blood showed a parasitaemia of 5% and displayed all developmental stages of the parasite, resembling the asplenic simian model of malaria.     

New guidelines for the prevention of imported malaria in France

Prevention of malaria is based on personal vector-control measures (PVCMs) to avoid mosquito bites at night and chemoprophylaxis if justified by the risk of contracting the disease. The most effective PVCM is the use of insecticide-treated mosquito nets. The decision to prescribe chemoprophylaxis, mainly to prevent Plasmodium falciparum infection, depends on the benefit-risk ratio. Overall, the risk of contracting malaria is 1,000-fold lower during a stay in the tropical regions of Asia or the Americas than in sub-Saharan Africa. For “conventional” stays (less than one month with nights spent in urban areas) in low-risk settings in tropical Asia and America, the risk of being infected with Plasmodium parasites (≤1/100,000) is equivalent or lower than that of experiencing serious adverse effects caused by chemoprophylaxis. Preventive medication is therefore no longer recommended. By contrast, in other settings and particularly in sub-Saharan Africa, chemoprophylaxis is the most effective measure against malaria. However, it is worth noting that no single preventive measure provides full protection. Regardless of the level of risk or chemoprophylaxis-related indication, protection against mosquito bites and rapid management of febrile illness after returning from an endemic area are also critical to prevent malaria. Finally, migrants of sub-Saharan origin visiting friends and relatives in their country of origin form a high-risk group who should be recommended chemoprophylaxis in the same way as any other travelers—with a preference for the least expensive molecules (doxycycline).