Original report| Volume 3, ISSUE 3, P136-139, March 1999

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Imported malaria in a Singapore Hospital: Clinical presentation and outcome

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      Objective: To evaluate the clinical presentation and outcome of imported malaria.
      Methods: A retrospective chart review was conducted of patients with imported malaria admitted to the Communicable Disease Centre (CDC), Singapore (a 130-bed tertiary referral center) from January 1992 to December 1993. An imported case was defined as a smear-positive infection that was acquired in another country.
      Results: Among 200 malaria patients hospitalized at CDC, 168 imported cases (137 males and 31 females, 131 nonresidents and 37 residents) were studied. The mean age was 31.6 ± 10.5 years. The countries visited were India (49.4%), Indonesia (16.7%), and Bangladesh (13%). Five patients had chemoprophylaxis and 36 patients had experienced previous malaria infection. The predominant symptoms were fever (97.6%), chills (79.2%), and rigors (67.9%). Hepatomegaly was detected in 56 (33.3%) and splenomegaly in 49 patients (29.2%). Plasmodium vivax was present in 132 patients, Plasmodium falciparum in 29, and mixed P. vivax and P. falciparum in 7 patients. Parasitemia ranged from 0.1 % to 8.0%. Of the vivax cases, 130 were treated with chloroquine, followed by primaquine in 123 patients. Quinine was given to 36 patients (29 falciparum malaria and 7 mixed infections). Median time to fever defervescence was 2 days. Complications occurred in three patients (2 with shock and 1 with pulmonary edema). According to World Health Organization gravity criteria, body temperature over 40°C was detected in six patients, bilirubinemia higher than 50 μmol/L in nine, parasitemia over 5% in five, glycemia less than 2.2 mmol/L in two patients. There were five relapses. No death was recorded.
      Conclusion: Plasmodium vivax is the most common cause of imported malaria, with the majority acquired from the Indian subcontinent. Only a few patients presented with severe malaria.



        • Murray C.J.L.
        • Lopez A.D.
        Global and regional cause of death patterns in 1990.
        Bull World Health Organ. 1994; 72: 429-445
        • Schultz M.G.
        Malaria in migrants and travellers.
        Trans R Soc Trop Med Hyg. 1989; 83 (Suppl): 31-34
        • Centres for Disease Control and Prevention
        Health information for international travel 1996–1997.
        US Government Printing Office, Washington, DC1997
        • Quarantine and Epidemiology Department
        Communicable disease surveillance in Singapore.
        Ministry of Environment, Singapore1993
        • Warrell D.A.
        • Molyreux M.E.
        • Beales P.E.
        Severe and complicated malaria.
        Trans R Soc Trop Med Hyg. 1990; 84: 1-65
        • World Health Organization
        A global strategy for malaria control.
        World Health Organization, Geneva1993
        • Centers for Disease Control and Prevention
        Malaria surveillance — United States, 1992.
        MMWR CDC Surveill Summ. 1995; 44: 7
        • Bradley D.
        • Warhurst D
        • Blaze M.
        • Smith V.
        Malaria imported into the United Kingdom in 1992 and 1993.
        Commun Dis Rep CDR Rev. 1994; 4: R169-R172
        • Lewis S.J.
        • Davidson R.N.
        • Rose E.J.
        • Hall A.P.
        Severity of imported falciparum malaria: effect of taking antimalarial prophylaxis.
        BMJ. 1992; 305: 741-743
        • Hengy C.
        • Gozal D.
        Diagnosis of malaria during chloroquine/proguanil prophylaxis [Letter].
        Lancet. 1990; 355: 121
        • Jelinek T.
        • Nothdurft H.D.
        • Loscher T.
        Malaria in nonimmune travellers: a synopsis of history, symptoms and treatment in 160 patients.
        J Travel Med. 1994; 1: 199-202
        • Winters R.A.
        • Murray H.W.
        Malaria: the mime revisited: fifteen more years of experience at a New York City teaching hospital.
        Am J Med. 1992; 93: 243-246
        • Alfandari S.
        • Santre C.
        • Chidiac C.
        • Senneville E.
        • Leroy O.
        • Beuscart C.
        • et al.
        Imported malaria: presentation and outcome of 111 cases.
        Clin Microbiol Infect. 1996; 2: 86-90
        • Behrens R.H.
        • Poyce D.I.
        Trends and presenting features of malaria in travellers from the UK.
        Trans R Soc Trop Med Hyg. 1993; 87: 361
        • Phillips-Howard P.A.
        • Radolowicz A.
        • Mitchell J.
        • Bradley D.J.
        Risk of malaria in British residents returning from malarious areas.
        BMJ. 1990; 300: 499-503
        • Calleri G.
        • Macor A.
        • Leo G.
        • Caramello P.
        Imported malaria in Italy: epidemiologic and clinical studies.
        J Travel Med. 1994; 1: 231-233