Imported malaria in metropolitan France, from recommendations to clinical practice – proposal for improvement - 15/09/21

Doi : 10.1016/j.idnow.2021.08.002

A. Dupré ^a, N. Argy ^b,^c,^d, S. Houze ^b,^c,^d, A. Leleu ^e, C. Choquet ^e, S. Matheron ^a,^f, A. Bleibtreu ^a,^g,⁎
^a Service des maladies infectieuses et tropicales, hôpital Bichat-Claude-Bernard, groupe hospitalier universitaire AP-HP Nord, AP–HP, Paris, France
^b Laboratoire de parasitologie, hôpital Bichat – Claude-Bernard, Paris, France
^c Centre national de référence du paludisme, hôpital Bichat–Claude-Bernard, Paris, France
^d MERIT UMR 261, faculté de pharmacie, université de Paris, Paris, France
^e Département des urgences, hôpital Bichat–Claude-Bernard, Paris, France
^f UMR 1137 Inserm, université Paris Diderot, Paris, France
^g Service de maladies infectieuses et tropicales, hôpitaux universitaires Pitié-Salpêtrière Charles Foix, Sorbonne Université, AP–HP, Paris, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 15 September 2021
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Highlights

•	France remains the most affected country in continental Europe by malaria outside the endemic zone.
•	Only a quarter of patients with simple attack and criteria for hospitalization were actually hospitalized.
•	The biological workup defined by the SPILF guidelines to assess for severity criteria is frequently incomplete.
•	Managing patients with vomiting during malaria remains difficult despite guidelines.
•	Less than 50% of patients had complete outpatient follow-up (D28).

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Abstract

Background

Approximately 5000 cases of imported malaria are observed each year in metropolitan France. Guidelines for the prevention and management of imported malaria were published by the French infectious disease society (French acronym SPILF) in 2017.

Objective

Study objective was to describe in a retrospective analysis (2015–2016) imported malaria cases recorded in a Parisian hospital, to analyze the congruence to previous guidelines (2014), deviation in respect to post hoc published guidelines and potential areas for improvement.

Results

Two hundred and one cases were analyzed using medical charts. There was a majority of men (sex ratio 2/1), with a mean age of 43 years at diagnosis. The main area of infection acquisition was sub-Saharan Africa (97%). The average time since return from the endemic area was 20 days. Patients consulted the emergency department for flu-like syndrome (32%), fever or chills (28%), and gastrointestinal symptoms (22%). Blood smears mainly identified Plasmodium falciparum (n=180, 90%). There were 52 (26%) severe malaria episodes.

Conclusion

The analysis of national guideline adequacy highlighted difficulties in obtaining a complete biological workup at baseline, managing patients with vomiting, and in the post-treatment follow-up.

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Keywords : Imported malaria, P. falciparum, P. vivax, Prophylaxis