engleski

Malaria in patients treated at Universitiy hospital for infectious diseases Zagreb, Croatia in the period from 2000 to 2015

Introduction: Malaria has been eradicated in Croatia. Imported malaria cases are mainly seeing among tourists, occupational travellers, less frequent among immigrants from endemic countries. The aim of the study was to analyse demographic aspect, clinical presentation, treatment and outcome of patients with malaria treated at our hospital in the period from 2000 to 2015. Methods: We conducted a retrospective survey on patients with malaria, treated at the University Hospital for Infectious Diseases, Zagreb, Croatia in the period from 2000 to 2015. Malaria was confirmed by the presence of parasites in peripheral blood by microscopy. The data collected from patient's clinical charts were analysed. Results: In the period from 2000 to 2015, 58 patients were treated for malaria (51 male and 7 female). The median age was 41 year, interquartile range (IQR) was 34-53 year. 45 (77.6%) of the patients were occupational travellers, 2 (3.4%) tourists, 6 (10%) immigrants (3 adopted children), 1 (2%) was a VFR (visiting friends and relatives) traveller and 4 (7%) were unkown. 46 (79%) patients acquired malaria in sub-Saharan Africa and 12 (21%) in SE Asia. Regarding the length of stay, 10 (17%) patients recorded travel less than one month, 20 (34%) 1-6 months, 8 (14%) 6-12 months, 19 (33%) more than 12 months and for 1 was uknown. 37 (64 %) patients were not taking chemoprophylaxis. The median time from onset of symptoms to the diagnosis (TSD) was 4 days (IQR 3G7 days). P. falciparum infection was detected in 36 (62%), P. vivax in 16 (28%) and mixed infection in 6 (10%) patients. All patients had fever, headache had 24 (41%), splenomegaly 25 (43%), thrombocytopenia 47 (81%). The median parasitaemia on admittance was 7, 5 ‰ (IQR 2-16‰). Hyperparasitaemia (>20‰) on admittance was detected in 10 (17 %) patients with P. falciparum infection. Six of these patients developed severe complicated malaria and were treated in intensive care unit with intravenous artesunate (completed with a full course of artemether-lumefantrine) and supportive treatment (artificial ventilation, hemodyalisis). Patients with TSD <3 days had lower parasitaemia (median 3, 5 ‰, IQR 1-12‰) than those with TSD >3days (median 9‰, IQR 3-25‰). Among 30 patients with uncomplicated falciparum malaria, 9 patients were treated with quinine-doxycycline (QD), 19 patients with artemether-lumefantrine (AL), 2 patients with mefloquine. All patients (100%) treated with AL and 18 % treated with QD had a parasite clearance time (PCT) of three days. All patients survived. Conclusion: Majority of our patients were long-term occupational travelers who did not take chemoprophylaxis. The patients with severe falciparum malaria were treated with artesunate iv successfully and without side effects. In order to reduce the time from onset of symptoms to malaria diagnosis, education for physician and travellers on the topic is needed. The current recommendations on malaria treatment (artemisinin-based combination therapy for uncomplicated falciparum malaria and artesunate iv for severe malaria) should be implemented in our clinical practice.

Malaria; Treatment; Croatia

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