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Background. Although malaria is frequent in travelers, it is often misdiagnosed on initial presentation, especially in children. The objective of this study is to describe epidemiology, clinical and laboratory presentation, and treatment of children with malaria in the United States. Methods. We performed a retrospective review of 50 confirmed cases of malaria from two pediatric metropolitan hospitals in Atlanta, GA, from 2000 to 2008. Results. Malarial smears were performed in 385 unique patients; 50 (12.6%) were positive. American children who had visited family and friends in malaria-endemic countries comprised 62% of our cases. Most cases visited Nigeria or Cameroon; all but three traveled to Africa. Three patients presented 8 to 12 months following travel. Plasmodium falciparum was diagnosed most frequently (72%). Most patients had low-level parasitemia (<1%). Gametocytes were rarely identified. Treatment was primarily with quinine and either doxycycline or clindamycin, and transfusion was rare. All patients responded rapidly to treatment. Although seven (14%) had hyperparasitemia (>5%), no fatalities or long-term sequelae were seen. Conclusions. Malarial diagnosis can be difficult in children because parasitemia is usually below 1%. A high index of suspicion is required in patients who have traveled to Africa. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the prevalence of Helicobacter pylori infection in patients undergoing upper endoscopy in the Republic of Georgia.

Summary: Objectives: Helicobacter pylori causes gastritis, duodenal ulcers, and gastric cancer. Although household crowding, low socioeconomic status (SES), and poor sanitation are associated with infection elsewhere, risk factors of infection in the Republic of Georgia (ROG), a country with a high prevalence rate (>70%), remain unknown. In this study we explored potential risk factors of infection among symptomatic patients in ROG. Methods: During 2007–2008, we prospectively recruited 390 subjects with gastrointestinal symptoms referred to five tertiary care centers for diagnostic upper endoscopy. We administered a questionnaire on potential risk factors and tested patients using three diagnostic tests: gastric biopsies underwent histological evaluation and rapid urease test (CLO test), and an ELISA was used to detect IgG against H. pylori in serum. We defined a case as having two or more positive results from the three available tests. Univariate and multivariate logistic regression analyses were performed. Results: Overall, 217 (56%) patients met the study case definition. Subjects diagnosed with cancer had the highest rate of H. pylori infection (62%), followed by those with gastritis (55%), and ulcer (54%). Age >30 years (adjusted odds ratio (aOR 2.6, 95% confidence interval (CI) 1.6–4.3) and residing in the capital city (aOR 0.6, 95% CI 0.4–0.9) were significantly associated with infection. Conclusions: In this large cohort with gastrointestinal symptoms, only age >30 years and living in the capital were significant factors associated with infection. Lower SES, less education, and crowding did not confer an increased risk, in contrast to the findings of previous studies. Population-based studies are needed to identify potential routes and risk factors of H. pylori infection in ROG. [ABSTRACT FROM AUTHOR]