Naslov
Malaria in patients treated at Universitiy hospital for infectious diseases Zagreb, Croatia in the period from 2000 to 2017

Autori
Dragobratović, Anja ; Baličević, Marina ; Lukas, Davorka ; Begovac, Josip

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Skup
1st South-East European Conference on Travel, Tropical, Migration Medicine and HIV & 2nd Croatian Congress on Travel, Tropical, Migration Medicine & HIV

Mjesto i datum
Dubrovnik, Hrvatska, 28.09.2017. - 01.10.2017

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
Malaria ; treatment

Sažetak
GOAL: to analyse demographic aspect, clinical presentation, treatment and outcome of patients with malaria treated at our hospital in between years 2000. and 2017. MATERIALS AND 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 2017. 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 2017, 72 patients were treated for malaria (63 male and 9 female). The median age was 44 years. 53 (73.61%) patients were occupational travellers, 6 (8.33%) were tourists, 6 (8.33%) immigrants, 1 (1.39%) was a visiting friends and relatives (VFR) traveller and for 6 (8.33%) patients the reason of travel was unkown. Most of our patients (63, or 87.5%) acquired malaria in Sub- Saharan Africa. Of the remaining, 5 (6.94%) were infected in SE Asia, 2 (2.77) in the Middle East, 1 (1.39%) in South America and 1 (1.39%) in Oceania. Regarding the length of stay, 16 (22.22%) patients recorded travel less than one month, 25 (34.72%) 1-6 months, 10 (13.89%) 6-12 months, 19 (26.39%) more than 12 months and for 2 length was unknown. Considerable number of our patients (48 or 66.67 %) were not taking chemoprophylaxis. The median time from onset of symptoms to the diagnosis (TSD) was 7 days. P. falciparum infection was detected in 44 (61.11%), P. vivax in 16 (22.22%), and 7 (9.72%) had mixed infection. Of the remaining 5 patients 4 were infected with P. ovale and 1 with P. malariae. All patients had fever, and the second most common symptom was headache which was reported by 32 (44.44%) patients. On examination hepatosplenomegaly was found in 30 (41.67%) patients. Initial laboratory tests most commonly revealed thrombocytopenia (57 patients, or 79.17%), with median platelet count of 104x109/L. Anemia was detected in 14 (19.44%) patients. The median parasitemia on admittance was 2.7% (0.1% - 27%). Hyperparasitemia (>2%) was detected in 13 (18.06 %) patients, all with P. falciparum infection. Seven of those developed severe complicated malaria and were treated in intensive care unit- 2 with intravenous quinine, and 5 with intravenous artesunate, completed with a full course of AL. Delayed hemolysis after treatment with intravenous artesunate was observed in one patient, but without requirement for transfusion. Among 38 patients with uncomplicated falciparum malaria, 9 were treated with quinine-doxycycline (QD), 27 with artemether-lumefantrine (AL), 2 patients with mefloquine.All patients (100%) treated with AL had a parasite clearance time (PCT) of 3 days. All patients survived. CONCLUSION: Malaria is eradicated in Croatia, and all cases are imported. Majority of our patients were long-term occupational travelers who did not take chemoprophylaxis. The patients with severe falciparum malaria were treated with artesunate successfully, with only one patient developing delayed hemolysis, but without requirement for transfusion. In order to reduce the time from onset of symptoms to malaria diagnosis, education for physicians and travellers on the topic is needed. The current recommendations on malaria treatment (artemisinin-based combination therapy for uncomplicated falciparum malaria and artesunate for severe malaria) should be implemented in our clinical practice.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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