How should Travel-Related Malaria Management in Emergency Departments of Non-endemic Countries? Single-center Study

Abstract

ABSTRACT Purpose: Advancements in air travel enabled an increase in traveling to malaria-endemic countries such as those in sub Saharan Africa. An increase in the incidence of imported malaria accompanied these advancements. This study aims to summarize how malaria patients who have imported the disease into non-endemic countries present to the emergency departments and to enlighten physicians in emergency departments by providing suggestions for practical approaches to handling such situations. Methods: This study was conducted retrospectively in a university hospital, from January 1, 2014 to March 1, 2022. Eight years of emergency department records of patients who were examined in the emergency department with a suspected, or definitive diagnosis of malaria were included in the study. Epidemiological and clinical characteristics were evaluated. Results: 892 patients were admitted to the emergency department with suspicion of malaria. Thirty of these patients were diagnosed with malaria, and 846 of the 892 patients were members of airline cabin crews. 94.3% (n=798) of the cabin crew did not use prophylactic medication for malaria. The mean age of the patients was 33.2±8.5. Twenty-five patients were diagnosed via peripheral blood smears, and the remaining three patients were diagnosed with polymerase chain reaction (PCR). Rapid diagnostic tests were positive in 26 out of 28 patients. Conclusion: The risk of acquiring malaria is still high despite short-term visits and airport-limited stays. Travel history should be routinely asked of patients with fever by emergency physicians. Education of people traveling to malaria endemic countries, including cabin crew, regarding malaria prophylaxis and protective measures to prevent mosquito bites plays a crucial role in preventing malaria.