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Copyright of Children's Nurses: Italian Journal of Pediatric Nursing Science / Infermieri dei Bambini: Giornale Italiano di Scienze Infermieristiche Pediatriche is the property of Societa Italiana di Scienze Infermieristiche Pediatriche and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

More than 100 years have passed since the discovery of its aetiological agent, but malaria is still the first cause of morbidity and mortality in the world. After the initial illusory successes of the fight against the infection, malarial infection is currently in a phase of expansion due to the sum of several contributory factors: the rise of anophelism related to the failure of eradication campaigns in endemic areas, due to environmental, structural and economic causes; the spread of stocks of chloroquine-resistant Plasmodium falciparum in such areas; the increase in travel for work and tourism, and the flows of populations due to wars, political issues, or just survival. In this paper we inspected all the aspects of the infection, from historical aspects - in which there was sometimes a mingling of history and legend - to those more properly defined as scientific. We seek to point out less well-known details, both about the vector and the clinical-epidemiological aspects concerning the populations in endemic areas, semi-immune subjects and foreigners. We also underline the importance both of prophylaxis and treatment of infection in travellers in high-risk areas, in the light of pharmacological resistance developed by the parasite and of the new usable molecules.

The beginning of the third millennium has been characterized by the emerging and progressive characterization of a novel malaria Plasmodium pathogen of simian origin (Plasmodium knowlesi), which now represents the fifth human malaria parasite. Evolutionary, environmental, and diagnostic-clinical features are briefly outlined on the ground of the most recent literature evidences.

Microscopic detection of parasites has been the reference standard for malaria diagnosis for decades. Recently rapid antigen assays provide an effective tool for the detection of malaria in symptomatic patients. In Novara Maggiore della Carità Hospital we evaluated the efficacy of the ParaSight F test in patients with malaria.

Vector borne diseases are infections transmitted by arthropods. The vector can mechanically spread the infectious disease or give hospitality to microrganisms for their biological cycle. The etiologic agents of these infections are viruses as yellow fever and Dengue, protozoans as plasmodium of malaria, Leishmania spp., bacteria as Borrelia burgdorferi, Rickettsia spp. or worms as lymphatic filariasis. They are emerging infectious diseases for the epidemiological changes of our national territory (ex. Lyme disease) but especially for the significant increase of the imported forms. Malaria is the more important infection for its clinical management but also for its remote possibility of a further transmission in Italy. In this review are illustrated the recent progresses in the diagnosis, treatment and prevention of the main vector borne infections that the clinical physicians may frequently observe. It is very important to know these diseases because an adequate preparation and continuous updating are necessarily required.

There is a significant increase in cases of malaria in Italy. The incidence among Italian citizens has remained quite stable since 1990, while the number of cases among foreigners residing in Italy has continued to increase. The clinical manifestations of plasmodium infection can be less evident in these people: they often have only mild complaints for weeks or months. The case of a Senegalese woman with Plasmodium malariae infection is presented. She had been in Italy for 13 months and was 4-month pregnant. Her only symptoms were asthenia and microcytic anemia; she was afebrile. Her anemia was initially believed to be due to iron deficiency: she was treated with iron and folic acid. The anemia worsened, and resolved only after antimalarial therapy with chloroquine.

It occasionally happens that patients don't suspect to have malaria and diagnosis becomes difficult for the Emergency Department physicians. Since September 1995 to February 1999, 8 cases of malaria have been diagnosed in our first aid station; 5 occurred in european and 3 in extraeuropean immigrants. Incidence of imported malaria was greater after holiday period for european, and equally distributed along the year for immigrants. Patients' provenience was sub-Saharian Africa and Asia. Standard blood examination and thick and thin blood smears were performed showing P. falciparum and P. malariae infection. All patients were successfully treated with mefloquine as recommended. The aspecificity of the symptoms and signs makes diagnosis difficult if malaria is not suspected, in presence of fever in people returning from the tropics. Even in presence of symptoms and abnormal laboratory examinations, diagnosis is possible only with microscopic blood examination.

Although knowledge of mutual relations between malaria and pregnancy remain incomplete, malaria is a very real risk for both mothers and foetuses in tropical country obstetrics. On the basis of personal experience in Somalia, some theoretical premises are reported on relations between malaria and pregnancy and a consolidated therapeutic protocol is illustrated.

The author's relieve the increase of number of the cases of malaria verified during the previous years in Italy, in subjects coming from malaria regions. The social and medical implications of this phenomenon are remarked. Epidemiology, pathology, immunology, clinical features and therapy of "imported malaria" are briefly elucidated. The new refined methods for the diagnosis (serological tests: Immunofluorescence - FAT and IFA - Enzyme linked immuno-sorbent assay - Elisa - Radio-immuno assay, Merozoite inhibition in culture) are described. The elaboration of a human malaria vaccine is analysed theoretically and practically. The imported malaria is a disease that every physician must recognize and treat.

A case of malaria caused by Plasmodium vivax is reported in order to underline the importance of correct pharmacological prophylaxis and meticulous anamnestic and epidemiological investigations.

Among 210 cases of imported malaria, officially notified in Lombardy from 1976 to 1980, we have selected 142 hospitalized patients and, about these, we got detailed informations on the stay in malaria endemic areas, on chemoprophylaxis and on their principal clinical data. We have found statistically significant correlations between P. falciparum infection and all the most frequent values in every class of epidemiological parameters considered, particularly with provenience from tropical African countries, touristic motivation, stay less than 30 days in winter season, onset of the illness within 20 days after the return in Italy, diagnostic lag shorter than 10 days after the onset and fever remission 2 or more days after starting specific treatment. There is also a tight correlation between these clinical parameters and the absence of individual chemoprophylaxis. The definition of these factors of risk is particularly useful to plan out some programs of prevention that should managed by regional Centers.