{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:27:55Z","timestamp":1789705675626,"version":"4.0.1"},"reference-count":24,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,5]]},"abstract":"<jats:p>Malaria acquired in endemic areas poses a substantial risk to travelers arriving in or returning to the United States. Timely diagnosis and recognition of severe illness are crucial; however, many U.S.-based clinicians lack familiarity with this disease. We conducted a retrospective review of 100 cases of malaria in adults seen at a single urban university hospital during 2000\u20132017. Descriptive and analytical statistics were calculated, including logistic regression modeling case severity. Most of the patients presented with <jats:italic>Plasmodium falciparum<\/jats:italic> (76%), most commonly after travel from sub-Saharan Africa (94%)<jats:italic>.<\/jats:italic> Prior malaria experience was common (50%), but adherence to a prophylactic regimen was exceedingly rare (4%). Twenty-one patients had severe malaria, including 10 with cerebral malaria. Severity was predicted by high parasitemia, bandemia, hypoglycemia, and hypotension at the time of presentation. In 24 patients, the initial treatment regimen was changed, usually because of the appearance of clinical deterioration or drug toxicity. One patient required intravenous artesunate. All patients survived, although one suffered fetal loss. Among 30 patients initially evaluated at other institutions, 43% had been treated for an alternative diagnosis. The most common reasons for transfer of patients to our hospital were inadequate facilities and lack of expertise with malaria. There needs to be increased awareness among U.S.-based travelers and clinicians regarding malaria as a potentially lethal condition, emphasizing the use of appropriate prophylaxis. Our simple model of disease severity could serve frontline physicians when deciding which patients should be admitted to the intensive care unit or transferred for higher level care.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0608","type":"journal-article","created":{"date-parts":[[2018,10,23]],"date-time":"2018-10-23T07:00:59Z","timestamp":1540278059000},"page":"1511-1517","source":"Crossref","is-referenced-by-count":10,"title":["Characteristics and Severity of Disease among 100 Cases of Imported Malaria Seen at a U.S. University Hospital, 2000\u20132017"],"prefix":"10.4269","volume":"99","author":[{"given":"Hana","family":"Akselrod","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Swierzbinski","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaonian","family":"Zheng","sequence":"additional","affiliation":[{"name":"Milken Institute School of Public Health, George Washington University, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Keiser","sequence":"additional","affiliation":[{"name":"Department of Pathology, George Washington University School of Medicine and Health Sciences; Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Parenti","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary L.","family":"Simon","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"MMWR Surveill Summ","first-page":"1","article-title":"Malaria surveillance\u2013United States, 2015","volume":"67","author":"Mace","year":"2018"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"98","article-title":"The geography of imported malaria to non-endemic countries: a meta-analysis of nationally reported statistics","volume":"17","author":"Tatem","year":"2017"},{"key":"b3","series-title":"Malar J","first-page":"293","article-title":"Malaria after international travel: a GeoSentinel analysis, 2003-2016","volume":"16","author":"Angelo","year":"2017"},{"key":"b4","series-title":"Emerg Infect Dis","first-page":"790","article-title":"Region-specific, life-threatening diseases among international travelers from Israel, 2004\u20132015","volume":"24","author":"Avni","year":"2018"},{"key":"b5","series-title":"CMAJ Open","first-page":"E352","article-title":"Malaria in travelers returning or migrating to Canada: surveillance report from CanTravNet surveillance data, 2004\u20132014","volume":"4","author":"Boggild","year":"2016"},{"key":"b6","series-title":"J Travel Med","first-page":"1","article-title":"Business travel-associated illness: a GeoSentinel analysis","volume":"25","author":"Chen","year":"2018"},{"key":"b7","series-title":"Am J Trop Med Hyg","first-page":"213","article-title":"Malaria-related hospitalizations in the United States, 2000\u20132014","volume":"97","author":"Khuu","year":"2017"},{"key":"b8","series-title":"Procedures for Detecting Blood Parasites. Diagnostic Medical Parasitology","first-page":"129","author":"Garcia","year":"2016"},{"key":"b9","series-title":"JAMA","first-page":"1370","article-title":"Fever in a traveler returning from Africa","volume":"317","author":"Herc","year":"2017"},{"key":"b10","author":"Centers for Disease Control and Prevention","year":"2017"},{"key":"b11","series-title":"J Infect Dev Ctries","first-page":"770","article-title":"Clinical characteristics of imported malaria: an 11-year experience in a Serbian referral center","volume":"10","author":"Poluga","year":"2016"},{"key":"b12","series-title":"J Infect Dis","first-page":"753","article-title":"Defining the effectiveness of antimalarial chemotherapy: investigation of the lag in parasite clearance following drug administration","volume":"214","author":"Khoury","year":"2016"},{"key":"b13","series-title":"Lancet","first-page":"717","article-title":"Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial","volume":"366","author":"Dondorp","year":"2005"},{"key":"b14","series-title":"Lancet","first-page":"1647","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"},{"key":"b15","series-title":"Guidelines for the Treatment of Malaria","author":"World Health Organization","year":"2015"},{"key":"b16","series-title":"Malar J","first-page":"151","article-title":"Severe malaria in Canada, 2001\u20132013","volume":"14","author":"McCarthy","year":"2015"},{"key":"b17","series-title":"N Engl J Med","first-page":"313","article-title":"Artesunate for malaria","volume":"359","author":"Arguin","year":"2008"},{"key":"b18","series-title":"Trop Dis Travel Med Vaccines","first-page":"1","article-title":"Malaria in the returning older traveler","volume":"2","author":"Allen"},{"key":"b19","series-title":"Am J Trop Med Hyg","first-page":"1532","article-title":"Epidemiology of imported malaria cases in Japan, 2006\u20132014: a sentinel traveler surveillance approach","volume":"97","author":"Kanayama","year":"2017"},{"key":"b20","series-title":"Open Forum Infect Dis","first-page":"1","article-title":"Rapid-antigen test negative malaria in a traveler returning from Thailand, molecularly diagnosed as Plasmodium knowlesi","volume":"3","author":"Mackroth","year":"2016"},{"key":"b21","series-title":"J Infect Dis","first-page":"265","article-title":"A systematic review: performance of rapid diagnostic tests for the detection of Plasmodium knowlesi, Plasmodium malariae, and Plasmodium ovale monoinfections in human blood","volume":"218","author":"Yerlikaya","year":"2018"},{"key":"b22","author":"Centers for Disease Control and Prevention","year":"2018"},{"key":"b23","series-title":"IDCases","first-page":"63","article-title":"Artesunate-related fever and delayed hemolysis in a returning traveler","volume":"2","author":"Lahoud","year":"2015"},{"key":"b24","series-title":"Am J Trop Med Hyg","first-page":"24","article-title":"A deadly wait for U.S. health insurance coverage\u2013sitting on the couch with malaria","volume":"99","author":"Schultz","year":"2018"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/6\/article-p1511.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/6\/article-p1511.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/6\/article-p1511.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T20:39:01Z","timestamp":1722458341000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/6\/article-p1511.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,5]]},"references-count":24,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.18-0608","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,5]]}}}