326) including 23 cases presented in children under 12 Immigrant

326) including 23 cases presented in children under 12. Immigrants (recently arrived and VFR) were younger than SD-208 manufacturer the other groups of travelers (p < 0.001). Epidemiological data in the different study groups are shown in Table 1. The most prevalent species was P. falciparum (143 cases, 84.1%), acquired mostly in Africa (97.9%); one case was acquired in India, one in Laos, and one in Ecuador. Plasmodium vivax was detected in 20 cases (11.8%), 6 of them acquired in Africa, 3 cases in Asia (India), and 3 cases in South America (1 in Ecuador, 1 in Brazil, and 1 in Peru). Infections produced by Plasmodium ovale (four cases, 2.4%) and Plasmodium malariae (two cases, 1.2%) were always acquired in sub-Saharan Africa.

One mixed infection due to P. falciparum and P. malariae was observed (0.6%). It was acquired in Equatorial Guinea. Parasitemia levels were studied in 144 cases: it was low (<1%) in 20.8%, moderate (1%–5%) in 58.3%, and high (>5%) in 20.8%. All cases with high parasitemia were caused by P. falciparum. Samples from five recent immigrants with negative microscopic examination were diagnosed with P. falciparum infection

using PCR assay. Molecular diagnosis contributed to identify Plasmodium species in another three patients with low parasitemia, infected with P. ovale (two) and P. vivax (one). Fever was the main symptom and was selleck screening library present in 93.5% of the cases, but it was less frequent in recently arrived immigrants group (p < 0.001). In fact, four of these immigrants were apyretic during the whole episode, and consulting referring macroscopic hematuria, generalized edema

because of a nephrotic syndrome, parotid tumor and abdominal Cyclooxygenase (COX) pain with splenomegaly, and asthenia linked to severe anemia (hemoglobin 5.7 g/dL). The most common laboratory abnormalities were thrombocytopenia (64.1%), presented more frequently in sailors than in the other groups, and anemia (34.9%), that was presented less frequently in tourists and business travelers. Clinical presentation and laboratory findings are summarized in Table 2. The most frequent regimens used were based on quinine, usually combined with doxycycline. Other combinations used, mainly in children, included: quinine + clindamicin, quinine + trimethoprim–sulfamethoxazole, and quinine + sulfadoxine–pyrimethamine. Treatment regimens used are summarized in Table 3. Almost 80% (77.6%) of patients were admitted to hospitals for treatment and control, and outpatients accounted for the 22.4%. However, oral administration was preferred in at least 87 (51.2%) patients. One strain of P. vivax imported from Asia presented tolerance to primaquine, and it was necessary to use higher doses of the drug in two different times for the patient treatment regimen. At least one indicator of severe malaria was present in 39 cases (22.9%), of those 19 (11.2%) required attention in critical care units. Renal failure (74.4%), followed by acute respiratory distress syndrome (33.3%) and disseminated intravascular coagulation (33.

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