{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:44:50Z","timestamp":1790923490795,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Spanish Ministry of Science and Innovation and State Research Agency","award":["CEX2018\u2013000806-S"],"award-info":[{"award-number":["CEX2018\u2013000806-S"]}]},{"name":"CIBER-Consorcio Centro de Investigaci\u00f3n Biom\u00e9dica en Red","award":["CB 2021"],"award-info":[{"award-number":["CB 2021"]}]},{"name":"Generalitat de Catalunya through the CERCA Program and AGAUR program","award":["2021 SGR 01558"],"award-info":[{"award-number":["2021 SGR 01558"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Early diagnosis is key to reducing the morbi-mortality associated with P. falciparum malaria among international travellers. However, access to microbiological tests can be challenging for some healthcare settings. Artificial Intelligence could improve the management of febrile travellers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data from a multicentric prospective study of febrile travellers were obtained to build a machine-learning model to predict malaria cases among travellers presenting with fever. Demographic characteristics, clinical and laboratory variables were leveraged as features. Eleven machine-learning classification models were evaluated by 50-fold cross-validation in a Training set. Then, the model with the best performance, defined by the Area Under the Curve (AUC), was chosen for parameter optimization and evaluation in the Test set. Finally, a reduced model was elaborated with those features that contributed most to the model.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of 11 machine-learning models, XGBoost presented the best performance (mean AUC of 0.98 and a mean F1 score of 0.78). A reduced model (MALrisk) was developed using only six features: Africa as a travel destination, platelet count, rash, respiratory symptoms, hyperbilirubinemia and chemoprophylaxis intake. MALrisk predicted malaria cases with 100% (95%CI 96\u2013100) sensitivity and 72% (95%CI 68\u201375) specificity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The MALrisk can aid in the timely identification of malaria in non-endemic settings, allowing the initiation of empiric antimalarials and reinforcing the need for urgent transfer in healthcare facilities with no access to malaria diagnostic tests. This resource could be easily scalable to a digital application and could reduce the morbidity associated with late diagnosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jtm\/taae054","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T17:55:31Z","timestamp":1712339731000},"source":"Crossref","is-referenced-by-count":12,"title":["MALrisk: a machine-learning\u2013based tool to predict imported malaria in returned travellers with fever"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0194-7736","authenticated-orcid":false,"given":"Leire","family":"Balerdi-Sarasola","sequence":"first","affiliation":[{"name":"ISGlobal , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]},{"name":"Universitat de Barcelona , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6574-4586","authenticated-orcid":false,"given":"Pedro","family":"Fleitas","sequence":"additional","affiliation":[{"name":"ISGlobal , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]},{"name":"Universitat de Barcelona , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Bottieau","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine , Antwerp ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blaise","family":"Genton","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health, University of Lausanne , Lausanne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5030-1915","authenticated-orcid":false,"given":"Paula","family":"Petrone","sequence":"additional","affiliation":[{"name":"ISGlobal , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]},{"name":"Universitat de Barcelona , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"ISGlobal , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]},{"name":"Universitat de Barcelona , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4215-6030","authenticated-orcid":false,"given":"Daniel","family":"Camprub\u00ed-Ferrer","sequence":"additional","affiliation":[{"name":"ISGlobal , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]},{"name":"Universitat de Barcelona , Hospital Cl\u00ednic, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"2024121419381709500_ref1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/MD.0b013e3180305c48","article-title":"Fever after a stay in the tropics: diagnostic predictors of the leading tropical conditions","volume":"86","author":"Bottieau","year":"2007","journal-title":"Medicine (Baltimore) [Internet]"},{"key":"2024121419381709500_ref2","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1093\/fampra\/cmu063","article-title":"Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel","volume":"31","author":"Hagmann","year":"2014","journal-title":"Fam Pract [Internet]"},{"key":"2024121419381709500_ref3","first-page":"1","article-title":"Aetiology of fever in returning travellers and migrants: a systematic review and meta-analysis","volume":"27","author":"Buss","journal-title":"J Travel Med"},{"key":"2024121419381709500_ref4","article-title":"European Centre for Disease Prevention and Control(ECDC)","author":"Report","year":"2023","journal-title":"Surveillance Report Malaria"},{"key":"2024121419381709500_ref5","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1016\/S0140-6736(10)61924-1","article-title":"Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial","volume":"376","author":"Dondorp","year":"2010","journal-title":"Lancet [Internet]"},{"key":"2024121419381709500_ref6","doi-asserted-by":"crossref","first-page":"102408","DOI":"10.1016\/j.tmaid.2022.102408","article-title":"Prevalence, anti-malarial chemoprophylaxis and causes of deaths for severe imported malaria: a systematic review and meta-analysis","volume":"49","author":"Mahittikorn","year":"2022","journal-title":"Travel Med Infect Dis"},{"key":"2024121419381709500_ref7","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1093\/cid\/ciab133","article-title":"Intravenous Artesunate for the treatment of severe imported malaria: implementation, efficacy, and safety in 1391 patients","volume":"73","author":"Roussel","year":"2021","journal-title":"Clin Infect Dis [Internet]"},{"key":"2024121419381709500_ref8","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.eimc.2013.12.014","volume-title":"Diagnosis and treatment of imported malaria in Spain: Recommendations from the Malaria Working Group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) [Internet]","author":"Mu\u00f1oz","year":"2015"},{"key":"2024121419381709500_ref9","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.jinf.2016.02.001","article-title":"UK malaria treatment guidelines 2016","volume":"72","author":"Lalloo","year":"2016","journal-title":"J Infect [Internet]"},{"key":"2024121419381709500_ref10","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/S0213-005X(15)30014-8","article-title":"Enfermedades Infecciosas y Microbiolog\u00eda Cl\u00ednica PUBLICACI\u00d3N OFICIAL DE LA SOCIEDAD ESPA\u00d1OLA DE ENFERMEDADES INFECCIOSAS Y MICROBIOLOG\u00cdA CL\u00cdNICA Enfermedades Infecciosas y Microbiolog\u00eda Cl\u00ednica Diagn\u00f3stico microbiol\u00f3gico de la malaria importada","volume":"33","author":"Torr\u00fas","year":"2015","journal-title":"Enferm Infecc Microbiol Clin [Internet]"},{"key":"2024121419381709500_ref11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1578","volume-title":"JAMA","author":"Taylor","year":"2010  10"},{"key":"2024121419381709500_ref12","first-page":"758","volume-title":"Pattern recognition and machine learning","author":"Bishop","year":"2006"},{"key":"2024121419381709500_ref13","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1145\/2347736.2347755","article-title":"A few useful things to know about machine learning","volume":"55","author":"Domingos","year":"2012","journal-title":"Communications of the ACM"},{"key":"2024121419381709500_ref14","first-page":"584","volume-title":"Machine learning for clinical decision support in infectious diseases: a narrative review of current applications","author":"Peiffer-Smadja","year":"2020"},{"key":"2024121419381709500_ref15","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10030541","article-title":"Machine-learning-based disease diagnosis: a comprehensive review","volume":"10","author":"Ahsan","year":"2022  15","journal-title":"Healthc (Basel, Switzerland) [Internet]"},{"key":"2024121419381709500_ref16","doi-asserted-by":"crossref","first-page":"103198","DOI":"10.1016\/j.pdpdt.2022.103198","article-title":"Application of machine and deep learning algorithms in optical microscopic detection of plasmodium: a malaria diagnostic tool for the future","volume":"40","author":"Ikerionwu","year":"2022","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"2024121419381709500_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.trsl.2017.12.004","article-title":"Image analysis and machine learning for detecting malaria","volume":"194","author":"Poostchi","year":"2018","journal-title":"Transl Res"},{"key":"2024121419381709500_ref18","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/6902321","article-title":"Modern machine-learning predictive models for diagnosing infectious diseases","volume":"2022","author":"Alqaissi","year":"2022  9","journal-title":"Comput Math Methods Med"},{"key":"2024121419381709500_ref19","doi-asserted-by":"crossref","first-page":"51","DOI":"10.20544\/HORIZONS.B.04.1.17.P05","article-title":"An overview of the supervised machine learning methods","volume":"4","author":"Nasteski","year":"2017","journal-title":"HorizonsB"},{"key":"2024121419381709500_ref20","doi-asserted-by":"crossref","first-page":"128","DOI":"10.14445\/22312803\/IJCTT-V48P126","article-title":"Supervised machine learning algorithms: classification and comparison","volume":"48","author":"Osisanwo","year":"2017","journal-title":"Int J Comput Trends Technol"},{"key":"2024121419381709500_ref21","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taac002","article-title":"Causes of fever in returning travelers: a European multicenter prospective cohort study","volume":"29","author":"Camprub\u00ed-Ferrer","year":"2022  21","journal-title":"J Travel Med"},{"key":"2024121419381709500_ref22","first-page":"2825","article-title":"Scikit-learn: machine learning in python","volume":"12","author":"Pedregosa","year":"2011","journal-title":"J Mach Learn Res [Internet]"},{"key":"2024121419381709500_ref23","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1038\/s41551-018-0304-0","article-title":"Explainable machine-learning predictions for the prevention of hypoxaemia during surgery","volume":"2","author":"Lundberg","year":"2018","journal-title":"Nat Biomed Eng [Internet]"},{"key":"2024121419381709500_ref24","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1109\/SIBGRAPI51738.2020.00053","volume-title":"Proc - 2020 33rd SIBGRAPI Conf Graph Patterns Images","author":"Marcilio","year":"2020"},{"key":"2024121419381709500_ref25","doi-asserted-by":"crossref","first-page":"470","DOI":"10.4269\/ajtmh.18-0736","article-title":"Diagnostic value of platelet and leukocyte counts in the differential diagnosis of fever in the returning Traveler","volume":"100","author":"Rubio","year":"2019","journal-title":"Am J Trop Med Hyg [Internet]"},{"key":"2024121419381709500_ref26","first-page":"1","article-title":"Arbo-score: a rapid score for early identification of patients with imported Arbovirosis caused by dengue, chikungunya and Zika virus","volume":"8","author":"Vellere","year":"2020","journal-title":"Microorganisms [Internet]"},{"key":"2024121419381709500_ref27","doi-asserted-by":"crossref","first-page":"104151","DOI":"10.1016\/j.compbiomed.2020.104151","article-title":"Machine learning model for predicting malaria using clinical information","volume":"129","author":"Lee","year":"2021","journal-title":"Comput Biol Med"},{"key":"2024121419381709500_ref28","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1186\/s12916-020-01823-3","article-title":"Machine learning approaches classify clinical malaria outcomes based on haematological parameters","volume":"18","author":"Morang\u2019a","year":"2020","journal-title":"BMC Med"},{"key":"2024121419381709500_ref29","author":"World Health Organization","year":"2022"},{"key":"2024121419381709500_ref30","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taab159","article-title":"Pandemic-related delay of falciparum malaria diagnosis in a traveller leading to cerebral malaria","volume":"28","author":"Schubert","year":"2021  29","journal-title":"J Travel Med"},{"key":"2024121419381709500_ref31","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-021-03750-x","article-title":"Longitudinal study based on a safety registry for malaria patients treated with artenimol-piperaquine in six European countries","volume":"20","author":"Vignier","year":"2021  8","journal-title":"Malar J"}],"container-title":["Journal of Travel Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jtm\/advance-article-pdf\/doi\/10.1093\/jtm\/taae054\/57451987\/taae054.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jtm\/article-pdf\/31\/8\/taae054\/61149760\/taae054.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jtm\/article-pdf\/31\/8\/taae054\/61149760\/taae054.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T19:38:34Z","timestamp":1734205114000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jtm\/article\/doi\/10.1093\/jtm\/taae054\/7641506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,5]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,4,5]]},"published-print":{"date-parts":[[2024,12,10]]}},"URL":"https:\/\/doi.org\/10.1093\/jtm\/taae054","relation":{},"ISSN":["1195-1982","1708-8305"],"issn-type":[{"value":"1195-1982","type":"print"},{"value":"1708-8305","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,12]]},"published":{"date-parts":[[2024,4,5]]},"article-number":"taae054"}}