Imported pediatric malaria presenting to an urban pediatric emergency department: a case series.

OBJECTIVE

The objective of this study was to identify common presenting signs, symptoms, and laboratory findings of imported pediatric malaria presenting to a US pediatric emergency department (ED).

METHODS

This is a retrospective chart review of all patients presenting to an urban pediatric ED between July 1, 2004, and July 1, 2011, who were assigned an ED or inpatient discharge diagnosis of "malaria" and had a confirmed blood smear demonstrating plasmodium species.

RESULTS

There were 21 patients included in this study (median age, 12 years; range, 19 months to 22 years). A total of 15 (71%) were infected with Plasmodium falciparum subtype of malaria. Patients presented to the ED between 1 day and 2 years after return from a malaria-endemic area. All 21 patients (100%) reported a history of fever, but only 9 (43%) had a fever documented in the ED. Of the patients, 14 (66%) complained of headache, 13 (62%) complained of anorexia, 11 (52%) complained of chills, and 10 (48%) complained of abdominal pain. The most common sign was tachycardia, present in 18 patients (86%). Consistent with other studies, thrombocytopenia was the most frequently observed laboratory abnormality, present in 16 patients (76%).

CONCLUSIONS

The presenting signs and symptoms of imported pediatric malaria are nonspecific and inconsistently present, underscoring the importance of maintaining a high index of suspicion for this diagnosis in any patient returning from a malaria-endemic region.