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Abstract：
Malaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation.
A total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34-0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia.
After 10 years of surveillance, a moderate increase in malaria incidence was observed, mostly P. vivax cases imported from the Indian sub-continent. Although severe malaria cases have been frequently reported, none of the patients died and organ sequelae were rare. Conceivably, the participation of the Primary Care and the District and Third Level Hospital professionals defining surveillance, diagnostic tests, referral criteria and clinical management can be considered a useful tool to minimize malaria morbi-mortality.
A total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34-0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia.
After 10 years of surveillance, a moderate increase in malaria incidence was observed, mostly P. vivax cases imported from the Indian sub-continent. Although severe malaria cases have been frequently reported, none of the patients died and organ sequelae were rare. Conceivably, the participation of the Primary Care and the District and Third Level Hospital professionals defining surveillance, diagnostic tests, referral criteria and clinical management can be considered a useful tool to minimize malaria morbi-mortality.
摘要：
疟疾仍然是旅行者死亡率的主要来源。2007年，一项协商一致的多中心初级保健-医院关于旅行前化学预防的共享指南，在巴塞罗那北部都会区建立了输入性疟疾的诊断和临床管理。该研究的目的是评估该地区疟疾病例的演变及其实施10年的临床管理。
共190例疟疾病例，都是进口的,已被记录下来。总体估计的疟疾粗发病率为每10,000人口/年0.47例（95％CI0.34-0.59），具有轻微的正斜率，尤其是以印度次大陆间日疟原虫病例增加为代价。参加旅行前咨询的患者人数较少（13.7％），接受处方化学预防的患者（10％）也较少。34例（17.9％）患者被诊断出严重的疟疾，其中2.6％的患者需要进入ICU。在3例患者出院时记录器官后遗症(2例肾功能衰竭和1例急性后窘迫呼吸综合征),尽管这三个人都在30天康复。没有一个病人死亡。符合严重程度标准的患者为男性（p=0.04），来自非洲（p=0.02），主要是非移民旅客（p=0.01），并在医院就诊（p<0.001）。最常见的物种是恶性疟原虫(64.2%)，间日疟原虫（23.2%），疟原虫(1.6%)和卵形疟原虫(1.1%)。被诊断为恶性疟原虫疟疾的患者更多来自撒哈拉以南非洲（p<0.001），而患有间日疟原虫的患者主要来自印度次大陆（p=0.003）。在进行免疫层析抗原检测的126例患者中，其中12.1%的结果被认为是假阴性。假阴性结果可能与<1%寄生虫血症的病例有关。
经过10年的监视,观察到疟疾发病率适度增加，主要是从印度次大陆进口的间日疟原虫病例。尽管经常报告严重的疟疾病例，没有患者死亡，器官后遗症罕见。可以想象,初级保健和地区和三级医院专业人员的参与定义监测，诊断测试,转诊标准和临床管理可被视为降低疟疾死亡率的有用工具.
共190例疟疾病例，都是进口的,已被记录下来。总体估计的疟疾粗发病率为每10,000人口/年0.47例（95％CI0.34-0.59），具有轻微的正斜率，尤其是以印度次大陆间日疟原虫病例增加为代价。参加旅行前咨询的患者人数较少（13.7％），接受处方化学预防的患者（10％）也较少。34例（17.9％）患者被诊断出严重的疟疾，其中2.6％的患者需要进入ICU。在3例患者出院时记录器官后遗症(2例肾功能衰竭和1例急性后窘迫呼吸综合征),尽管这三个人都在30天康复。没有一个病人死亡。符合严重程度标准的患者为男性（p=0.04），来自非洲（p=0.02），主要是非移民旅客（p=0.01），并在医院就诊（p<0.001）。最常见的物种是恶性疟原虫(64.2%)，间日疟原虫（23.2%），疟原虫(1.6%)和卵形疟原虫(1.1%)。被诊断为恶性疟原虫疟疾的患者更多来自撒哈拉以南非洲（p<0.001），而患有间日疟原虫的患者主要来自印度次大陆（p=0.003）。在进行免疫层析抗原检测的126例患者中，其中12.1%的结果被认为是假阴性。假阴性结果可能与<1%寄生虫血症的病例有关。
经过10年的监视,观察到疟疾发病率适度增加，主要是从印度次大陆进口的间日疟原虫病例。尽管经常报告严重的疟疾病例，没有患者死亡，器官后遗症罕见。可以想象,初级保健和地区和三级医院专业人员的参与定义监测，诊断测试,转诊标准和临床管理可被视为降低疟疾死亡率的有用工具.
