Recognition and management of imported malaria in children

Imported malaria has become an increasingly significant cause of mortality and morbidity in children traveling from areas of the world endemic for malaria. Reasons for this trend include international travel, immigration, emergence of drug-resistant strains of plasmodium, and inadequate chemoprophylaxis. The clinical features of malaria in children are generally nonspecific and similar to other common conditions, resulting in missed or delayed diagnosis. Children are more likely than adults to deteriorate rapidly and to develop severe malaria, particularly cerebral malaria. It is therefore important that malaria is suspected in any child who has a history of travel to a malaria-endemic area and presents with nonspecific symptoms. Diagnosis should be made early with repeated thick and thin blood smears. Appropriate antimalarial therapy and supportive care should be instituted as soon as possible. Despite appropriate and prompt therapy, the mortality remains high in severe pediatric malaria, especially cerebral malaria. Copyright (C) 2000 by W.B. Saunders Company.