Commentary: Should patients with imported malaria routinely be admitted?

摘要

Malaria remains an important infection in Europe, with several thousand cases imported each year. D'Acremont et al pose an important question-should these cases routinely be admitted for treatment? Most people agree that non-falciparum malaria can be treated without admission. Falciparum malaria has more serious implications. It claims over a million lives a year, including some in Europe. Several factors combine to make it difficult to assess severity at the time of diagnosis. If the parasites are mature almost all will be sequestrated, giving a misleadingly low peripheral parasitaemia. Conversely, if the parasites are young the patient may seem well but deteriorate rapidly over 24 hours as the parasites mature and begin to sequester in vital organs. This can occur despite adequate treatment; drugs such as quinine have a limited effect on early stages. Patients may therefore deteriorate rapidly despite adequate anti-malarial treatment.