Authors: Jasem Alshamsi, Zahra Kasim, Ithar Othman, Andleeb shadan, Hamid Hussain, Asima Ujra, LindaElsamani, Laila Aldabal
Background: Malaria still constitutes a major global health burden, with 214 million cases diagnosed globally in 2015 which resulted in almost 500,000 case fatalities secondary to the infection. In 2007, the United Arab Emirates (UAE) was declared officially as Malaria Free Country. However, in view of the demographic nature of the country, imported malaria remains as a major cause of fever in returning or visiting travelers diagnosed in all emirates across the country. Malaria Vivax and Malaria Falciparum are the most commonly diagnosed types of malaria and patients are usually arriving form com Indian subcontinent and Africa.
Objectives: This study aims to look into the Clinical and Epidemiological profiles of imported Malaria cases presenting to Rashid Hospital, Dubai in 2017-2018.
Methodology: A retrospective medical record review of patients above the age of 13 years who presented to our hospital as fever in a returning/visiting traveler and had a confirmed diagnosis of imported malaria from April 2017 until October 2018. Patient’s demographic, clinical and laboratory data were collected, and WHO severity criteria were used for severity classification among admitted patients.
Results: From April 2017 to October 2018, we had 628 malaria patients. 90.1% of these patients were male, and around 48.1% were of Pakistani nationality. It was noticed that we had a significant number of vivax cases as compared to falciparum and further analysis revealed that vivax malaria was the predominant subtype in patients from Pakistan and Indian subcontinent, whereas in those from African descent such as Nigeria and Kenya; Falciparum malaria outweighed the numbers of vivax., thereby reconfirming the prevalence and predominance of falciparum in that region. Only one patient out of the 628 presented with a Glasgow coma scale (GCS) of less
than 11 and three patients presented with seizures as the initial presentation. The majority of the patients had a classical history of, nighttime fever and generalized body aches. 3 out of the total number of patients went on to have complications of ARDS. Laboratory values of all patients were looked into, in order to assess for indicators of severity five out of the 628 patients had an abnormal PH result four patients had an abnormal hemoglobin result 57 patients showed derangement in bilirubin values. 65.1% had normal glucose and 86 patients had normal creatinine values. One patient was found to have a positive blood culture. Out of the 628 patients, 247 patients proved to be candidates for admission based on clinical and laboratory parameters with only 84 patients meeting the criteria of at least one positive indicator of severity. Amongst the admitted patients 86.9% were males, with age range of a minimum 15 years to a maximum age of 57 years. The majority of them being vivax cases, and out of whom 62 required admission and the average days of admission were about 3.6 days.
Conclusion: Most of the imported malaria cases admitted to hospital had at least one indicator of severity; nevertheless, there were no mortality cases recorded over study period which reflects that optimal standards of care have been implemented.
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