Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region

Abstract Background Malaria is endemic in countries located in tropical and sub-tropical regions. The increasing flow of domestic and international travellers has made malaria a relevant health problem even in non-endemic regions. Malaria has been described as the main diagnosis among travellers pre...

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Main Authors: Andréa Beltrami Dotrário, Lucas José Bazzo Menon, Valdes Roberto Bollela, Roberto Martinez, Daniel Cardoso de Almeida e Araújo, Benedito Antônio Lopes da Fonseca, Rodrigo de C. Santana
Format: Article
Language:English
Published: BMC 2016-05-01
Series:Malaria Journal
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12936-016-1347-x
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author Andréa Beltrami Dotrário
Lucas José Bazzo Menon
Valdes Roberto Bollela
Roberto Martinez
Daniel Cardoso de Almeida e Araújo
Benedito Antônio Lopes da Fonseca
Rodrigo de C. Santana
author_facet Andréa Beltrami Dotrário
Lucas José Bazzo Menon
Valdes Roberto Bollela
Roberto Martinez
Daniel Cardoso de Almeida e Araújo
Benedito Antônio Lopes da Fonseca
Rodrigo de C. Santana
author_sort Andréa Beltrami Dotrário
collection DOAJ
description Abstract Background Malaria is endemic in countries located in tropical and sub-tropical regions. The increasing flow of domestic and international travellers has made malaria a relevant health problem even in non-endemic regions. Malaria has been described as the main diagnosis among travellers presenting febrile diseases after returning from tropical countries. In Brazil, malaria transmission occurs mainly in the Amazon region. Outside this area, malaria transmission is of low magnitude. Methods This cross-sectional study aimed to describe the experience in the diagnosis of malaria in a reference centre located outside the Brazilian Amazon Region, emphasizing the differences in clinical and laboratory markers between cases of malaria and those of other febrile diseases (OFD). Medical charts from adult patients (≥18 years) who underwent a thick smear test (TST) for malaria, between January 2001 and December 2014, were retrospectively reviewed. Results A total of 458 cases referred to perform the TST were included. Malaria was diagnosed in 193 (42 %) episodes. The remaining 265 episodes (58 %) were grouped as OFD. The majority of malaria episodes were acquired in the Brazilian Amazon Region. The median time between the onset of symptoms and the TST was 7 days. Only 53 (11.5 %) episodes were tested within the first 48 h after symptom onset. Comparing malaria with OFD, jaundice, nausea, vomiting, and reports of fever were more prevalent in the malaria group. Low platelet count and elevated bilirubin levels were also related to the diagnosis of malaria. Conclusions The results indicate that outside the endemic area travellers presenting febrile disease suspected of being malaria underwent diagnostic test after considerable delay. The reporting of fever combined with a recent visit to an endemic area should promptly evoke the hypothesis of malaria. In these cases, specific diagnostic tests for malaria should be a priority. For cases that jump this step, the presence of elevated bilirubin or thrombocytopaenia should also indicate a diagnosis of malaria.
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spelling doaj.art-b2889eba9f01481f9ab8be868647b3a42022-12-21T23:51:17ZengBMCMalaria Journal1475-28752016-05-0115111110.1186/s12936-016-1347-xMalaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon RegionAndréa Beltrami Dotrário0Lucas José Bazzo Menon1Valdes Roberto Bollela2Roberto Martinez3Daniel Cardoso de Almeida e Araújo4Benedito Antônio Lopes da Fonseca5Rodrigo de C. Santana6Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP)Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP)Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP)Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP)Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP)Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP)Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP)Abstract Background Malaria is endemic in countries located in tropical and sub-tropical regions. The increasing flow of domestic and international travellers has made malaria a relevant health problem even in non-endemic regions. Malaria has been described as the main diagnosis among travellers presenting febrile diseases after returning from tropical countries. In Brazil, malaria transmission occurs mainly in the Amazon region. Outside this area, malaria transmission is of low magnitude. Methods This cross-sectional study aimed to describe the experience in the diagnosis of malaria in a reference centre located outside the Brazilian Amazon Region, emphasizing the differences in clinical and laboratory markers between cases of malaria and those of other febrile diseases (OFD). Medical charts from adult patients (≥18 years) who underwent a thick smear test (TST) for malaria, between January 2001 and December 2014, were retrospectively reviewed. Results A total of 458 cases referred to perform the TST were included. Malaria was diagnosed in 193 (42 %) episodes. The remaining 265 episodes (58 %) were grouped as OFD. The majority of malaria episodes were acquired in the Brazilian Amazon Region. The median time between the onset of symptoms and the TST was 7 days. Only 53 (11.5 %) episodes were tested within the first 48 h after symptom onset. Comparing malaria with OFD, jaundice, nausea, vomiting, and reports of fever were more prevalent in the malaria group. Low platelet count and elevated bilirubin levels were also related to the diagnosis of malaria. Conclusions The results indicate that outside the endemic area travellers presenting febrile disease suspected of being malaria underwent diagnostic test after considerable delay. The reporting of fever combined with a recent visit to an endemic area should promptly evoke the hypothesis of malaria. In these cases, specific diagnostic tests for malaria should be a priority. For cases that jump this step, the presence of elevated bilirubin or thrombocytopaenia should also indicate a diagnosis of malaria.http://link.springer.com/article/10.1186/s12936-016-1347-xMalariaDiagnosisAcute febrile illnessBrazilian AmazonPlasmodium falciparumPlasmodium vivax
spellingShingle Andréa Beltrami Dotrário
Lucas José Bazzo Menon
Valdes Roberto Bollela
Roberto Martinez
Daniel Cardoso de Almeida e Araújo
Benedito Antônio Lopes da Fonseca
Rodrigo de C. Santana
Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region
Malaria Journal
Malaria
Diagnosis
Acute febrile illness
Brazilian Amazon
Plasmodium falciparum
Plasmodium vivax
title Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region
title_full Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region
title_fullStr Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region
title_full_unstemmed Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region
title_short Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region
title_sort malaria and other febrile diseases among travellers the experience of a reference centre located outside the brazilian amazon region
topic Malaria
Diagnosis
Acute febrile illness
Brazilian Amazon
Plasmodium falciparum
Plasmodium vivax
url http://link.springer.com/article/10.1186/s12936-016-1347-x
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