Clinical and epidemiological features of imported malaria in the Republic of Crimea for a twenty-year period (1994-2014)

Aim. To identify the main clinical and epidemiological features of imported malaria in the Republic of Crimea for a twenty year period (1994-2014). Methods. Archival case reports, results of thin and thick blood films for malaria, a set of general clinical and biochemical laboratory parameters were assessed. Results. Over the past 20 years, 48 patients (including 47 men) aged 21 to 61 years were treated for imported malaria in the department of infectious diseases of the 7th City Clinical Hospital in Simferopol. 34 patients were diagnosed with Plasmodium falciparum malaria, 7 - with Plasmodium vivax malaria, 1 - with Plasmodium ovale malaria, 2 - with Plasmodium malariae malaria. Mixed infection (Plasmodium falciparum and Plasmodium ovale, Plasmodium falciparum and Plasmodium vivax) was revealed in 2 patients; in 2 cases the diagnosis was based on clinical and epidemiological data. Malaria was imported form Sierra Leone, Angola, Mali, Guinea, India, Yemen, Nigeria, Congo, Ghana, as well as from neighboring countries - Azerbaijan and Tajikistan. The clinical picture of Plasmodium falciparum malaria was characterized with diverse fever, absence of manifest chills and sweats, challenging the diagnosis. Plasmodium vivax malaria cases were typical with repeated fever, but were diagnosed late. Self-intake of antimalarial and antibacterial drugs, as well as inadequate chemoprophylaxis distorts the clinical picture of the disease and worsens the quality of laboratory diagnosis. Difficulties in film examinations were most common in cases of mixed-malaria and Plasmodium ovale malaria, requiring repeated tests performed by experienced professionals. Intravenous quinine should be added to treatment together with pyrimethamine + sulfadoxine (Fansidar) and artemisinin in cases of severe course of Plasmodium falciparum malaria associated with increasing parasitaemia. Conclusion. Imported malaria, mostly Plasmodium falciparum malaria, which is associated with the most severe clinical course, increased risk for complicated forms development and unfavorable outcome, is quite common in the Republic of Crimea. Mandatory testing of non-immunized persons returning from endemic areas with any change in well-being and active detection of malaria carriers among residents of endemic areas, arriving in non-endemic areas, are crucial for the early diagnosis of malaria.