Malaria in immigrant and traveler children: Clinical presentation and risk factors for complications

Article type: Research Article

Authors: Lavoie, Pascal M. | Carceller, Ana | Robert, Monique | Lebel, Marc H. | Moore, Dorothy L. | Rashed, Selim

Affiliations: Department of Pediatrics and Division of Infectious Diseases at CHU Sainte-Justine, University of Montreal, Canada | Division of Infectious Diseases, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada | Maisonneuve-Rosemont Hospital, University of Montreal, Canada

Note: [] Correspondence: Ana Carceller, MD, Department of Pediatrics, CHU Sainte-Justine, 3175 Côte Ste-Catherine, Montréal, Québec, H3T 1C5 Canada. Tel.: +1 514 345 4675; Fax: +1 514 345 4822; E-mail: [email protected]

Abstract: To review the clinical features and risk factors for complications and treatment of malaria in a pediatric cohort mainly composed of immigrant children. Retrospective cohort study of all cases of malaria diagnosed between 1991 and 2001 in Montreal, Canada. We have reviewed a total of 121 cases of malaria in children. The majority of which (78%) were immigrants or foreign-born visitors. Most children were originating from African countries and mainly infected with Plasmodium falciparum (63.9%, versus 21.0%, 5.9%, 3.4% for Plasmodium vivax), Plasmodium ovale and Plasmodium malariae} respectively). Seven patients (5.9%) were co-infected with more than one species. Median times from arrival to presentation were much shorter with P. falciparum (14 days) than other species: P. vivax (98 days), P. ovale (37 days) and P. malariae (31 days). The majority of children had fever, headache and rigors. Ten children (8.3%) had serious complications (cerebral malaria, anemia or shock). All ten patients presented within one month of arrival from their respective endemic country and all were infected with P. falciparum (P=0.03). Three patients required admission to a pediatric intensive care unit and seven required a blood transfusion. All recovered well although two children had P. falciparum recrudescence and three children infected with P. vivax or P. ovale relapsed. The number of complications observed in immigrant children was similar to that observed in travelers. Sickle cell disease was the most significant associated risk factor for serious complications of malaria (P<0.001). Immigrant children are at high risk of complications from malaria. Our study highlights sickle cell disease as a significant risk factor for serious complications of malaria in these children. It is essential to maintain a high index of suspicion in non-endemic areas in order to decrease the morbidity of malaria in immigrant children.

Keywords: Malaria, plasmodium, immigrant and traveler children

Journal: Journal of Pediatric Infectious Diseases, vol. 1, no. 1, pp. 29-37, 2006