Abstract
To review the clinical features and risk factors for complications and treatment of
malaria in a pediatric cohort mainly composed of immigrant children. Retrospective
cohort study of all cases of malaria diagnosed between 1991 and 2001 in Montreal,
Canada. We have reviewed a total of 121 cases of malaria in children. The majority
of which (78%) were immigrants or foreign-born visitors. Most children were originating
from African countries and mainly infected with Plasmodium falciparum (63.9%, versus 21.0%, 5.9%, 3.4% for Plasmodium vivax), Plasmodium ovale and Plasmodium malariae respectively). Seven patients (5.9%) were co-infected with more than one species.
Median times from arrival to presentation were much shorter with P. falciparum (14 days) than other species: P. vivax (98 days), P. ovale (37 days) and P. malariae (31 days). The majority of children had fever, headache and rigors. Ten children
(8.3%) had serious complications (cerebral malaria, anemia or shock). All ten patients
presented within one month of arrival from their respective endemic country and all
were infected with P. falciparum (P = 0.03). Three patients required admission to a pediatric intensive care unit and
seven required a blood transfusion. All recovered well although two children had P. falciparum recrudescence and three children infected with P. vivax or P. ovale relapsed. The number of complications observed in immigrant children was similar
to that observed in travelers. Sickle cell disease was the most significant associated
risk factor for serious complications of malaria (P < 0.001). Immigrant children are at high risk of complications from malaria. Our
study highlights sickle cell disease as a significant risk factor for serious complications
of malaria in these children. It is essential to maintain a high index of suspicion
in non-endemic areas in order to decrease the morbidity of malaria in immigrant children.
Keywords
Malaria - plasmodium - immigrant and traveler children
