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Artesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate. [ABSTRACT FROM AUTHOR]

Background. We conducted a prospective study to evaluate the aetiologies of fever in returning travelers and to identify the clinical and laboratory factors predictive of malaria in travelers returning from tropical areas with fever. Methods. We included those consulting for fever appearing less than 3 months after return. Destinations were classified according to the visited continent (America including Caribbean, Asia, Africa, Oceania). We prospectively included all returning travelers consulting our department between November 2002 and May 2003 for health problems and investigated those presenting fever within 3 months after return from a tropical country. We then conducted a case control study to identify factors predictive of malaria. Control group was defined as febrile travelers without malaria. Results. A total of 272 febrile travelers were included. They were 152 tourists (55.9%), 58 immigrants (21.3%), 33 expatriates (12.1%), and 29 business travelers (10.7%). Besides malaria (54 cases), the main diagnosis in the 218 controls were bacterial enteritis, bacterial pneumonia, infectious cellulitis, pyelonephritis, prostatis, dengue fever, primary viral infection (HIV, EBV, CMV, parvovirus B19), and tuberculosis. Multivariate regression analysis showed correlations between malaria and travel to Africa (OR = 11.9), abdominal pain (OR = 14.1), vomiting (OR = 19.4), myalgia (OR = 6.3), inadequate prophylaxis (OR = 10.1), and platelets <150,000/µL (OR = 25.2). Conclusions. Our results suggest that no single clinical or biological feature had both good sensitivity and specificity to predict malaria in febrile travelers seen as outpatients within 3 months after returning from the tropics. [ABSTRACT FROM AUTHOR]

Plasmodium falciparum malaria is a serious health hazard for travelers to malaria-endemic areas and is often diagnosed on return to the country of residence. We conducted a retrospective study of imported falciparum malaria among travelers returning to France from malaria-endemic areas from 1996 through 2003. Epidemiologic, clinical, and parasitologic data were collected by a network of 120 laboratories. Factors associated with fatal malaria were identified by logistic regression analysis. During the study period, 21,888 falciparum malaria cases were reported. There were 96 deaths, for a case-fatality rate of 4.4 per 1,000 cases of falciparum malaria. In multivariate analysis, risk factors independently associated with death from imported malaria were older age, European origin, travel to East Africa, and absence of chemoprophylaxis. Fatal imported malaria remains rare and preventable. Pretravel advice and malaria management should take into account these risk factors, particularly for senior travelers. [ABSTRACT FROM AUTHOR]

Background: Although between 8 and 19% of travelers consult a doctor after returning from the tropics, the full spectrum of health complaints is unknown. Methods: We analyzed the relative frequency of travel-associated health complaints in all travelers (immigrants returning from visiting their home countries, expatriates, business travelers, and tourists) consulting our department between November 2002 and May 2003. Results: A total of 622 patients were studied (256 women, 366 men; median age 38 yr; 45.3% tourists, 33.8% immigrants, 14.1% expatriates, 6.7% business travelers). The median duration of travel was 36.9 days. The main destinations were Africa (57.6%) and Asia (26.4%). A total of 637 diseases were diagnosed, distributed as follows: skin diseases (23.4%), gastrointestinal infections (19.1%), respiratory tract infections (11.5%), malaria (8.8%), schistosomiasis (7.2%), viral hepatitis (4.1%), urinary tract infections (3.5%), sexually transmitted infections (3.5%), tuberculosis (2.7%), dengue fever (2.5%), and others (13.8%). Malaria and intestinal tract infections accounted for 21% and 23% of diagnoses in the 257 febrile travelers, respectively. Overall, 230 diagnoses (36.1%) corresponded to imported tropical diseases, the main imported diseases being malaria, schistosomiasis, amebiasis, gastrointestinal disorders caused by intestinal nematodes, and dengue fever. Conclusions:Tropical diseases are not the leading cause of consultation in travelers returning from the tropics. Immigrants are the travelers most at risk of common tropical diseases, with the noteworthy exceptions of dengue fever and invasive schistosomiasis. [ABSTRACT FROM AUTHOR]

Describes a patient infected with West African trypanosomiasis after travelling to Central Africa. Development of a painless erythematous papule on the right ankle; Absence of adenopathy; Demonstration of a normal cell count in the examination of cerebrospinal fluid specimen; Diagnosis of a West African trypanomiasis at the hemolymphatic stage; Administration of intravenous pentamidine isothionate.

Little is known about severe imported Plasmodium falciparum malaria in industrialized countries where the disease is not endemic because most studies have been case reports or have included <200 patients. To identify factors independently associated with the severity of P. falciparum, we conducted a retrospective study using surveillance data obtained from 21,888 P. falciparum patients in France during 1996-2003; 832 were classified as having severe malaria. The global case-fatality rate was 0.4% and the rate of severe malaria was ≈3.8%. Factors independently associated with severe imported P. falciparum malaria were older age, European origin, travel to eastern Africa, absence of chemoprophylaxis, initial visit to a general practitioner, time to diagnosis of 4 to 12 days, and diagnosis during the fall-winter season. Pretravel advice should take into account these factors and promote the use of antimalarial chemoprophylaxis for every traveler, with a particular focus on nonimmune travelers and elderly persons. [ABSTRACT FROM AUTHOR]