{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:38:56Z","timestamp":1776692336683,"version":"3.51.2"},"reference-count":49,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Saudi Arabia has made significant progress toward malaria elimination; however, imported cases continue to occur, particularly in the southwestern regions. This study aimed to describe the clinical characteristics and outcomes of patients with malaria in the Aseer Region, Saudi Arabia. Methods: A retrospective observational study was conducted at Khamis Mushait General Hospital, Aseer Region, Saudi Arabia, including all patients with malaria from January 2022 to December 2025. Demographic, clinical, laboratory, and outcome data were extracted from the electronic medical records. Severe malaria was defined according to the World Health Organization criteria. Multivariate logistic regression using Firth\u2019s penalized maximum likelihood estimation was performed to identify independent predictors of severe malaria (\u22651 WHO criterion). Statistical analysis was performed using R software (version 4.2.1). Results: A total of 311 patients were included, predominantly male (90.0%), with a mean age of 28.8 \u00b1 11.3 years. Ethiopian nationals comprised nearly half the cases (48.2%), followed by Saudi (16.4%) and Yemeni (15.1%) nationals. Plasmodium vivax was the most common species (51.1%), followed by Plasmodium. falciparum (40.2%). Fever was the most frequent symptom (89.4%), followed by fatigue (50.8%), chills (46.9%), and vomiting (39.5%). Low parasitemia (&lt;1%) was the most frequent finding (33.8%), followed by moderate (27.3%) and mild (18.3%) levels, while high (4.2%) and very high parasitemia (1.9%) were uncommon. Severe malaria (\u22651 criterion) was diagnosed at 43.7%, with severe anemia (26.0%) and jaundice (23.2%) being the most frequent WHO severity criteria. Notably, 84% of the cases occurred during 2024\u20132025, indicating a recent outbreak, with a sharp peak of 43 cases in October 2024. Multivariate logistic regression identified two independent predictors of having at least one WHO severity criterion: higher parasitemia level (adjusted OR = 1.70 per 1% increase, 95% CI: 1.40\u20132.11, p &lt; 0.001) and non-Saudi nationality (adjusted OR = 2.40, 95% CI: 1.10\u20135.62, p = 0.027). Conclusions: Malaria in the Aseer Region predominantly affects young adult male expatriates, suggesting its imported nature. The predominance of P. vivax represents a shift from historical patterns. Parasitemia level and being of non-Saudi nationality independently predict severe malaria and may therefore support risk stratification and clinical decision-making. The dramatic case surge in 2024\u20132025 highlights regional vulnerability to outbreaks despite control progress. These findings support enhanced screening for at-risk populations, maintenance of clinical capacity for severe malaria management, and robust surveillance systems for early outbreak detection.<\/jats:p>","DOI":"10.3390\/tropicalmed11040108","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T12:01:22Z","timestamp":1776686482000},"page":"108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics and Outcomes of Malaria Patients in the Aseer Region, Saudi Arabia: A Retrospective Study (2022\u20132025)"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2077-1914","authenticated-orcid":false,"given":"Fouad Ibrahim","family":"Alshehri","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Khamis Mushayt Hospital, Khamis Mushait 62461, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhaifullah Ahmed","family":"Alkhosafi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Khamis Mushayt Hospital, Khamis Mushait 62461, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Essam Abdullah","family":"Al Asmari","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Khamis Mushayt Hospital, Khamis Mushait 62461, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulrahman Bin","family":"Saeed","sequence":"additional","affiliation":[{"name":"Community Medicine Department, Faculty of Medicine, King Abdelaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anas Mohammed","family":"Zarbah","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Khamis Mushayt Hospital, Khamis Mushait 62461, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed Ali","family":"Algarni","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Khamis Mushayt Hospital, Khamis Mushait 62461, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed Gasim","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Clinical Pathology, University of Gezira, Wad Madani 5118, Sudan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marim Abdallah","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Microbiology Department, Khamis Mushait General Hospital, Khamis Mushait 62441, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma Anter","family":"Mady","sequence":"additional","affiliation":[{"name":"Clinical Pathology, University of Gezira, Wad Madani 5118, Sudan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saleh Mohammed Zafer","family":"Albakri","sequence":"additional","affiliation":[{"name":"Public Health Department, Khamis Mushait General Hospital, Khamis Mushait 62441, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-706X","authenticated-orcid":false,"given":"Ramy Mohamed","family":"Ghazy","sequence":"additional","affiliation":[{"name":"Family and Community Medicine Department, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1038\/s41392-025-02246-3","article-title":"Malaria: Past, Present, and Future","volume":"10","author":"Li","year":"2025","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_2","first-page":"100076","article-title":"World Malaria Report 2025: Growing Biological Threats, Shrinking Resources","volume":"4","author":"Platon","year":"2026","journal-title":"Decod. Infect. Transm."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Acestor, N., Cooksey, R., Newton, P.N., M\u00e9nard, D., Guerin, P.J., Nakagawa, J., Christophel, E., Gonz\u00e1lez, I.J., and Bell, D. (2012). Mapping the Aetiology of Non-Malarial Febrile Illness in Southeast Asia through a Systematic Review\u2014Terra Incognita Impairing Treatment Policies. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0044269"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1001\/jama.2022.12366","article-title":"Diagnosis, Treatment, and Prevention of Malaria in the US: A Review","volume":"328","author":"Daily","year":"2022","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"44","DOI":"10.4174\/astr.2014.87.1.44","article-title":"Spontaneous Splenic Rupture in Plasmodium Vivax Malaria","volume":"87","author":"Kim","year":"2014","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_6","first-page":"0220","article-title":"An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases","volume":"5","author":"Romagosa","year":"2008","journal-title":"PLoS Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rosa-Gon\u00e7alves, P., Ribeiro-Gomes, F.L., and Daniel-Ribeiro, C.T. (2022). Malaria Related Neurocognitive Deficits and Behavioral Alterations. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.829413"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1186\/s12936-023-04805-x","article-title":"Examining the Disparities of Anti-Malarial Drug Consumption among Children under the Age of Five: A Study of 5 Malaria-Endemic Countries","volume":"22","author":"Hossain","year":"2023","journal-title":"Malar. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e00435","DOI":"10.1016\/j.parepi.2025.e00435","article-title":"Economic Burden of Malaria on Developing Countries: A Mini Review","volume":"30","author":"Mezieobi","year":"2025","journal-title":"Parasite Epidemiol. Control"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1186\/s12936-016-1581-2","article-title":"The Changing Malaria Landscape in Aseer Region, Kingdom of Saudi Arabia: 2000\u20132015","volume":"15","author":"Alshahrani","year":"2016","journal-title":"Malar. J."},{"key":"ref_11","unstructured":"(2026, February 24). Malaria Control in the Kingdom of Saudi Arabia|Field Epidemiology Training Program. Available online: https:\/\/www.saudifetp.org\/seb\/malaria-control-kingdom-saudi-arabia."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Alghamdi, R., Bedaiwi, A., and Al-Nazawi, A.M. (2024). Epidemiological Trends of Malaria Infection in Jeddah, Saudi Arabia, 2018\u20132023. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1476951"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s12936-021-03846-4","article-title":"Residual Malaria in Jazan Region, Southwestern Saudi Arabia: The Situation, Challenges and Climatic Drivers of Autochthonous Malaria","volume":"20","author":"Madkhali","year":"2021","journal-title":"Malar. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Elagali, A., Shubayr, M., Noureldin, E., Alene, K.A., and Elagali, A. (2024). Spatiotemporal Distribution of Malaria in the Kingdom of Saudi Arabia. Trop. Med. Infect. Dis., 9.","DOI":"10.3390\/tropicalmed9010016"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Coleman, M., Al-Zahrani, M.H., Coleman, M., Hemingway, J., Omar, A., Stanton, M.C., Thomsen, E.K., Alsheikh, A.A., Alhakeem, R.F., and McCall, P.J. (2014). A Country on the Verge of Malaria Elimination\u2014The Kingdom of Saudi Arabia. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0105980"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Al Zahrani, M.H., Omar, A.I., Abdoon, A.M.O., Ibrahim, A.A., Alhogail, A., Elmubarak, M., Elamin, Y.E., AlHelal, M.A., Alshahrani, A.M., and Abdelgader, T.M. (2018). Cross-Border Movement, Economic Development and Malaria Elimination in the Kingdom of Saudi Arabia. BMC Med., 16.","DOI":"10.1186\/s12916-018-1081-z"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15","DOI":"10.5144\/0256-4947.1998.15","article-title":"Clinical Aspects of Malaria in the Asir Region, Saudi Arabia","volume":"18","author":"Malik","year":"1998","journal-title":"Ann. Saudi Med."},{"key":"ref_18","unstructured":"(2026, April 07). World Malaria Report 2019. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241565721."},{"key":"ref_19","unstructured":"WHO (2020). WHO World Malaria Report: 20 Years of Global Progress and Challenges, World Health Organization."},{"key":"ref_20","unstructured":"WHO (2025). WHO Guidelines for Malaria 13 August 2025, WHO."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Magalh\u00e3es, R.J.S., and Clements, A.C.A. (2011). Mapping the Risk of Anaemia in Preschool-Age Children: The Contribution of Malnutrition, Malaria, and Helminth Infections in West Africa. PLoS Med., 8.","DOI":"10.1371\/journal.pmed.1000438"},{"key":"ref_22","unstructured":"MOH Publications (2026, February 26). Progress Towards Malaria Elimination in KSA: A Success Story, Available online: https:\/\/www.moh.gov.sa\/en\/Ministry\/MediaCenter\/Publications\/Pages\/Publications-2019-04-28-001.aspx."},{"key":"ref_23","unstructured":"WHO Team Global Malaria Programme World Health Organization (2024). World Malaria Report 2024: Key Facts and Figures, WHO."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Alharbi, B., and Ahmed, M. (2025). Malaria in Travelers and Local Populations: Comprehensive Study of Incidence Patterns and Origin-Based Classification in Saudi Arabia. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0335137"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.15537\/1658-3175.2184","article-title":"Imported Malaria Infections Diagnosed at the Malaria Referral Laboratory in Riyadh, Saudi Arabia","volume":"24","author":"Alkhalife","year":"2003","journal-title":"Saudi Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"007","DOI":"10.17352\/ojtm.000002","article-title":"Impact of Irrigation System on Malaria Transmission in Jazan Region, Saudi Arabia","volume":"1","author":"Alzahrani","year":"2017","journal-title":"Open J. Trop. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s12936-015-0697-0","article-title":"Characterization of Imported Malaria, the Largest Threat to Sustained Malaria Elimination from Sri Lanka","volume":"14","author":"Dharmawardena","year":"2015","journal-title":"Malar. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/s12936-017-1795-y","article-title":"An Intricate Case of Multidrug Resistant Plasmodium Falciparum Isolate Imported from Cambodia","volume":"16","author":"Fabrizio","year":"2017","journal-title":"Malar. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"834","DOI":"10.3201\/eid2504.181355","article-title":"Effects of Political Instability in Venezuela on Malaria Resurgence at Ecuador-Peru Border, 2018","volume":"25","author":"Sippy","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Sanclemente-Cardoza, V., Pay\u00e1n-Salcedo, H.A., and Estela-Zape, J.L. (2025). Severe Malaria Due to Plasmodium Falciparum in an Immunocompetent Young Adult: Rapid Progression to Multiorgan Failure. Life, 15.","DOI":"10.3390\/life15081201"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"293","DOI":"10.4269\/ajtmh.21-0316","article-title":"High Prevalence of Asymptomatic Malarial Anemia and Association with Early Conversion from Asymptomatic to Symptomatic Infection in a Plasmodium Falciparum Hyperendemic Setting in Cameroon","volume":"106","author":"Fogang","year":"2021","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"5585272","DOI":"10.1155\/2021\/5585272","article-title":"Thrombocytopenia as a Diagnostic Marker for Malaria in Patients with Acute Febrile Illness","volume":"2021","author":"Gebreweld","year":"2021","journal-title":"J. Trop. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"58","DOI":"10.4103\/2229-5070.113914","article-title":"Study of Thrombocytopenia in Patients of Malaria","volume":"3","author":"Gupta","year":"2013","journal-title":"Trop. Parasitol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"(2014). Severe Malaria. Trop. Med. Int. Health, 19, 7\u2013131.","DOI":"10.1111\/tmi.12313_2"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"110","DOI":"10.4103\/tp.tp_26_25","article-title":"Analysis of the Relationship between Malaria and Inflammatory Biomarker Levels in Children in Rural Iraq: Impact of Nutritional Deficiencies, Anemia, and Hematological Disorders","volume":"15","author":"Kareem","year":"2025","journal-title":"Trop. Parasitol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5725634","DOI":"10.1155\/2016\/5725634","article-title":"Malaria, Moderate to Severe Anaemia, and Malarial Anaemia in Children at Presentation to Hospital in the Mount Cameroon Area: A Cross-Sectional Study","volume":"2016","author":"Sumbele","year":"2016","journal-title":"Anemia"},{"key":"ref_37","unstructured":"(2026, February 26). Incidence of Jaundice in Plasmodium Vivax Malaria: A Prospective Study in Moodabidri, South India\u2014PMC, Available online: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4418110\/."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.actatropica.2016.03.031","article-title":"Malarial Hepatopathy: Clinical Profile and Association with Other Malarial Complications","volume":"159","author":"Jain","year":"2016","journal-title":"Acta Trop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jiph.2013.04.003","article-title":"Clinical Profile and Complication of Malaria Hepatopathy","volume":"6","author":"Fazil","year":"2013","journal-title":"J. Infect. Public Health"},{"key":"ref_40","first-page":"91","article-title":"Autoimmune Anemia in Malaria","volume":"36","author":"Rodriguez","year":"2019","journal-title":"Trends Parasitol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"11795476251332438","DOI":"10.1177\/11795476251332438","article-title":"A Rare Case of Hypoparathyroidism with Basal Ganglia Calcification in a 17-Year-Old Epileptic Patient Presenting with Falciparum Malaria, Thrombocytopenia and Anemia","volume":"18","author":"Memon","year":"2025","journal-title":"Clin. Med. Insights Case Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.4269\/ajtmh.14-0190","article-title":"Malaria-Induced Splenic Infarction","volume":"91","author":"Hwang","year":"2014","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"101073","DOI":"10.1016\/j.lanmic.2025.101073","article-title":"WHO World Malaria Report 2024","volume":"6","author":"Venkatesan","year":"2025","journal-title":"Lancet Microbe"},{"key":"ref_44","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":"ref_45","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jinf.2021.03.028","article-title":"Epidemiology and Clinical Outcomes of Severe Plasmodium Vivax Malaria in India","volume":"82","author":"Arya","year":"2021","journal-title":"J. Infect."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/S0035-9203(02)90099-4","article-title":"Severe Falciparum Malaria in Children: A Comparative Study of 1990 and 2000 WHO Criteria for Clinical Presentation, Prognosis and Intensive Care in Dakar, Senegal","volume":"96","author":"Imbert","year":"2002","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2147\/JBM.S394704","article-title":"Platelet Parameters and Their Correlation with Parasitemia Levels Among Malaria Infected Adult Patients at Jinella Health Center, Harar, Eastern Ethiopia: Comparative Cross-Sectional Study","volume":"14","author":"Asmerom","year":"2023","journal-title":"J. Blood Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1186\/s12936-018-2509-9","article-title":"Anaemia and Malaria","volume":"17","author":"White","year":"2018","journal-title":"Malar. J."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Kotepui, M., Piwkham, D., PhunPhuech, B., Phiwklam, N., Chupeerach, C., and Duangmano, S. (2015). Effects of Malaria Parasite Density on Blood Cell Parameters. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0121057"}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/4\/108\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T12:47:59Z","timestamp":1776689279000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/11\/4\/108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":49,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["tropicalmed11040108"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed11040108","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}