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Malaria in Tunisia: epidemiology, clinical aspects and management

Abstract number: P755

Kilani B., Ammari L., Tiouiri Benaïssa H., Abdelmalek R., Goubontini A., Kanoun F., Chaker E., Ben Chaabane T.

Objectives: To study the epidemiological, clinical, laboratory features and management of malaria in Tunisia where the disease has been eradicated since 1980. All the cases were imported, mainly from African countries.

Methods: Medical records were reviewed for patients with microscopically confirmed malaria diagnosed at our department during a twenty years period (from august 1986 to december 2006).

Results: 110 patients were included in the study. 90.9% of them were male, and median age was 30 years (range, 14–57). 52.7% of patients were caucasian.34.5% of them had history of malaria and were from Central Africa. Only 26% of cases had taken chemoprophylaxis with poor compliance, mainly in tunisian travellers. Of a total of 110 cases, 87 were caused by P. falciparum, 14 by P. vivax, 3 by P. ovale, 2 by P. malariae, 2 patients had dual infection and in 2 cases plasmodia were unspecified. 97% of cases were acquired in subsaharian Africa. All immigrants living in Tunisia have acquired infection in their countries of origin and develop symptoms after a journey. Tunisian people were infected outside the country while travelling for many reasons. 94% of patients gave history of fever; 29% however were afebrile at the time of their presentation. Other commonly but unspecific symptoms were headache, chills, myalgia and gastro-intestinal troubles. 38% of cases had jaundice.

Thrombocytopenia (<150,000/mm3) was the most prominent laboratory feature occurring in 41% of cases. Hemoglobin levels below 12 g/dl were observed in 22%. Leucopenia (<4000/mm3) was noted in 22%. Leukocytosis in 7%. ALT (>22U/l) was elevated in 40% of cases.

Diagnosis of malaria was made in asymptomatic African students in 7 cases. 2 patients (Tunisian) had severe falciparum malaria requiring treatment at the ICU.

For P. falciparum cases, mefloquine was the drug of choice, whereas chloroquine associated to primaquine was used for other species. All the patients recoverd well.

Conclusion: Malaria remains a major public health problem in many subsaharian countries. Due to the increased number of international travellers for many reasons, we should be altert to the reintroduction of the prevent disease in our country.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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