Document Detail

Imported malaria in immigrants to Italy: a changing pattern observed in north eastern Italy.
MedLine Citation:
PMID:  19796101     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Seventy percent of imported malaria cases in Italy occur in immigrants, generally with milder clinical presentation due to premunition acquired through repeated infections. Nevertheless, premunition could be progressively lost after a long period of nonexposure. We investigated the changing pattern of malaria in immigrants in two definite 5-year periods one decade apart. METHODS: We retrospectively examined the main laboratory findings of all malaria cases observed in immigrants from 1990 to 1994 and from 2000 to 2004. We stratified patients by reason for traveling: subjects in Italy who traveled to visit friends and relatives (VFR) or new immigrants (NI). RESULTS: Forty-eight cases of malaria in immigrants occurred from 1990 to 1994, while 161 were observed from 2000 to 2004. Patients admitted in the latter period had a significantly higher parasitemia (median 6,298 vs 3,360 trophozoites/microL, p= 0.028) and lower platelet count (median 96.5 vs 132 x 10(9)/L, p= 0.012) and hemoglobin (median 12.6 vs 13.4 g/dL, p= 0.049). While NI did not show any significant difference in the two study periods, in the VFR subgroup a higher parasitemia (median 8,845 vs 2,690 trophozoites/microL, p= 0.003) and lower platelet count (median 96 vs 131 x 10(9)/L, p= 0.034) were observed during the second period, during which three cases of severe malaria occurred in VFR. A longer stay in Italy was reported in VFR admitted during the second study period (median 8.3 vs 5.7 years). CONCLUSIONS: We found a changing pattern of malaria presentation in immigrants over a decade. The most likely explanation is the longer average stay outside endemic countries and subsequent loss of premunition observed in the second cohort. Immigrants living in Italy for some time and traveling to VFR should no more be considered a low-risk group for severe malaria. Pretravel advice should be particularly targeted to this group.
Marta Mascarello; Federico Gobbi; Andrea Angheben; Ercole Concia; Stefania Marocco; Mariella Anselmi; Geraldo Monteiro; Andrea Rossanese; Zeno Bisoffi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of travel medicine     Volume:  16     ISSN:  1708-8305     ISO Abbreviation:  J Travel Med     Publication Date:    2009 Sep-Oct
Date Detail:
Created Date:  2009-10-02     Completed Date:  2010-01-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9434456     Medline TA:  J Travel Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  317-21     Citation Subset:  IM    
Department of Infectious Diseases, University of Verona, Verona, Italy.
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MeSH Terms
Africa, Western
Emigration and Immigration*
Italy / epidemiology
Malaria, Falciparum / blood,  epidemiology*,  microbiology
Middle Aged
Parasitemia / epidemiology
Plasmodium falciparum / isolation & purification
Retrospective Studies
Young Adult

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