engleski

Malaria in Children: Our Clinical Experience in the Past 17 years

INTRODUCTION: In its latest report, the WHO estimated there is approximately 210 million cases of malaria worldwide with more than 400 000 deaths occuring mostly in the African region. Children, especially those under 5 years of age, are the most vulnerable group. The highest risk for severe disease and death is in this period between six months and five years of age, apparently due to lack of maternal immunity and the absence of a specific one. CASES PRESENTATION: Between January 2000 and January 2017 only three children (2 female and 1 male between 2 and 4 years of age) were hospitalized and treated for malaria at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević“ in Zagreb. They were all adopted from Kongo and have been living in Croatia for a short period of time (less than a year) before disease onset. Also they all had a history of past Plasmodium infection. In all three children the disease presented with fever over 39°C without the characteristic regular patterns of malaria, accompanied by chills, sweats, malaise, anorexia and gastrointestinal symptoms (abdominal pain and diarrhea). The time from the onset of symptoms to hospital admission was between 1 and 6 days. Physical examination revealed mild hepatomegaly in all patients and mild splenomegaly in two of them (Table 1). Noticeable laboratory findings included mild anemia and thrombocytopenia with mildly elevated ESR and CRP . None of our patients had jaundice (Table 2). The diagnosis was based on clinical presentation of disease and established by the presence of parasites in peripheral blood by microscopy. In one child PCR was used to confirm the species of malarial parasite. Diagnostic tests showed a mixed infection with Plasmodium falciparum and Plasmodium vivax or Plasmodium ovale in two patients, while one patient had only Plasmodium vivax infection. Hyperparasitaemia (50‰) was detected on admission in one child with mixed infection (Plasmodium falciparum and Plasmodium vivax). Other children had parasitaemia between 15 and 19‰ (Table 2). In one patient we also noticed concomitant intestinal infestation with Giardia lamblia. Despite the fact that in two patients diagnostic tests showed a mixed infection with Plasmodium falciparum, they all presented with mild and uncomplicated disease. In two patients the treatment was initially started with intravenous artesunate and followed by artemether-lumefantrine. The child with mixed Plasmodium falciparum and Plasmodium ovale infection was treated with artemether- lumefantrine only. The therapy was completed with primaquine for 14 days. The child with hyperparasitaemia received transfusion therapy with erythrocyte concentrate. There were no adverse effects of therapy observed in our patients. All patients survived and to our best knowledge none of them had additional attacks or relapses. CONCLUSION: In many European countries where malaria has been eradicated, there has been a substantial rise in the incidence of imported malaria in the last decades. Children who are travelling to endemic countries are at highest risk for acquiring severe forms of disease because most of them don´t have specific immunity. We treated only three children with imported malaria but they all had a mild and uncomplicated form of the disease, probably due to their immunity. An increasing number of refugees, travellers and adopted children in our country merits special attention in order to timely recognise, treat and avoid serious complications of malaria in this vulnerable group.

malaria ; children ; diagnostics ; treatment

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