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Malaria 

Malaria
Chapter:
Malaria
DOI:
10.1093/med/9780198729228.003.0087
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date: 19 November 2019

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes. Plasmodium falciparum causes the most severe disease and is responsible for most of the long-term complications and deaths related to malaria. In Europe, 5482 confirmed cases of malaria were reported in 2011 (annual incidence of around 1/100 000 population), with 83% of cases reported by four countries: France, United Kingdom, Germany, and Spain. Children account for 15-20% of reported cases. Most cases are diagnosed in black African children travelling with their families during school holidays to visit friends and relatives in their native countries. The diagnosis of malaria requires a high index of suspicion, highlighting the importance of seeking a travel history in all febrile children. Treatment varies according to the Plasmodium species responsible, national guidelines, antimalarial availability, and individual patient factors. All children suspected or diagnosed with P. falciparum malaria should be admitted to hospital for at least 24 hours because of the possibility of rapid progression in severity of malaria and poor tolerance of oral therapies. Severe imported malaria is associated with young age (under 5 years), delayed diagnosis, and non-immunity to malaria. In children with severe falciparum malaria, intravenous artesunate is now the treatment of choice because, although quinine remains effective, artesunate is associated with a survival advantage (relative risk reduction of 22.5%) and a significant reduction in clinical complications. If artesunate is not immediately available, then intravenous quinine is still indicated, and treatment should not be delayed while waiting for artesunate to become available. Case fatality remains low (around 1%).

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