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Volume 17, Number 5—May 2011

CME ACTIVITY

Severe Imported Plasmodium falciparum Malaria, France, 1996–2003

Elise Seringe, Marc Thellier, Arnaud Fontanet, Fabrice Legros, Olivier Bouchaud, Thierry Ancelle, Eric Kendjo, Sandrine Houze, Jacques Le Bras, Martin Danis, Rémy DurandComments to Author , and for the French National Reference Center for Imported Malaria Study Group
Author affiliations: Author affiliations: University Pierre et Marie Curie, Paris, France (E. Seringe, M. Thellier, M. Danis); Groupe Hospitalier Pitié-Salpĕtrière, Paris (E. Seringe, M. Thellier, M. Danis); Centre National de Référence du Paludisme, Paris (M. Thellier, F. Legros, E. Kendjo, S. Houze, J. Le Bras, M. Danis, R. Durand); Institut Pasteur, Paris (E. Seringe, A. Fontanet); Conservatoire National des Arts et Métiers, Paris (A. Fontanet); Hôpital Avicenne, Bobigny, France (O. Bouchaud, R. Durand); Hôpital Cochin, Paris (T. Ancelle)

Main Article

Table A1

Factors associated with severe malaria among patients treated for Plasmodium falciparum malaria in hospitals, France, 1996–2003*

Factor
No. (%) severe cases
No. (%) patients
Odds ratio (95% confidence interval)
p value
Total 832 (3.8) 21,888 NA NA
No. of deaths
96
NA
NA
NA
Age group, y
<15 127 (2.5) 5,098 (23.3) 1 <0.0001
16–30 177 (2.9) 6,107 (27.9) 1.2 (0.9–1.5)
31–45 207 (3.2) 6,421 (29.3) 1.3 (1.04–1.6)
46–60 229 (6.7) 3,429 (15.7) 2.8 (2.2–3.5)
>60
92 (11.04)
833 (3.8)
4.8 (3.7–6.4)

Sex
Female 251 (3.1) 8,091 (37) 1
Male 579 (4.2) 13,772 (63) 1.2 (1.1–1.3) <0.0001
Unknown
2
25
NA
NA
Origin and residence
African travelers 190 (1.9) 9,764 (44.6) 1 <0.0001
African residents 73 (2.6) 2,814 (12.9) 1.34 (1.02–1.80)
European travelers 386 (6.7) 5,805 (26.5) 3.60 (3.01–4.30)
European expatriates 98 (8.3) 1,188 (5.4) 4.5 (3.5–5.8)
Others
85 (3.7)
2,317 (10.6)
1.9 (1.5–2.5)

Region of malaria acquisition
Western Africa 527 (4.1) 12,941 (59.1) 1 <0.0001
Central Africa 182 (3.2) 5,738 (26.2) 0.8 (0.6–0.9)
Eastern Africa 27 (15.3) 176 (0.8) 4.3 (2.8–6.5)
Austral Africa 10 (6.1) 165 (0.8) 1.5 (0.8–2.9)
Madagascar and Comoros Islands 62(2.5) 2,449 (11.2) 0.6 (0.5–0.8)
Others 22 (5.4) 410 (1.9) 1.3 (0.9–2.1)
Unknown
2
9
NA

Duration of stay, d
0–21 220 (5.9) 3,748 (26.1) 1.5 (1.2–1.8) <0.0001
22–32 115 (3.4) 3,433 (23.9) 0.8 (0.6–1.1)
33–62 110 (2.9) 3,755 (26.1) 0.7 (0.5–0.9)
>62 138 (4.03) 3,424 (23.8) 1
Unknown
249 (3.3)
7,528
NA

Chemoprophylaxis
Appropriate drugs† 214 (3.6) 5,935 (30.4) 0.9 (0.7–1.1) 0.2
No chemoprophylaxis 403 (4) 10,097 (51.7) 1
Inappropriate drugs‡ 150 (4.3) 3,490 (17.9) 1.1 (0.9–1.3)
Unknown
65
2,366
NA

Season of diagnosis
Spring–summer 448 (3.1) 14,327 (65.6.) 1 NA
Fall–winter 379 (5.1) 7,511 (34.4) 1.5 (1.3–1.7) <0.0001
Unknown
5
50
NA
NA
Time lapse between return and onset, d
–25 to 0 194 (4.2) 4,569 (23.1) 1 0.15
1–7 252 (3.7) 6,863 (34.8) 0.90 (0.70–1.04)
7–14 172 (3.9) 4,415 (22.4) 0.9 (0.7–1.1)
14–30 96 (4) 2,397 (12.1) 0.9 (0.7–1.2)
>30 43 (2.9) 1,490 (7.5) 0.6 (0.5–0.9)
Unknown
75 (3.5)
2,154
NA

Time between onset and diagnosis, d
<3 367 (3.1) 11,899 (58.4) 1 <0.0001
4–6 234 (5.7) 4,082 (20.1) 1.9 (1.6–2.3)
7–12 125 (5.2) 2,401 (11.8) 1.7 (1.4–2.1)
>12 57 (2.9) 1,974 (9.7) 0.9 (0.7–1.2)
Unknown
49
1,532
NA

Time between return and diagnosis, d
0–5 221 (3.8) 5,838 (27.8) 1 0.09
6–10 172 (3.6) 4,851 (23.1) 0.9 (0.8–1.1)
11–15 179 (4.4) 4,061 (19.4) 1.2 (0.9–1.4)
>15 217 (3.5) 6,210 (29.6) 0.9 (0.8–1.1)
Unknown
43
928
NA

Place of first medical visit
Hospital 450 (3.1) 14,574 (69.5) 1 NA
General practitioner 351 (5.5) 6,420 (30.5) 1.8 (1.5–2.1) <0.0001
Unknown
31
894
NA
NA
Parasitemia, %
<1 156 (1.3) 12,322 (67.9) 1 <0.0001
1.1–2 69 (3.2) 2,146 (11.8) 2.6 (1.9–3.4)
2.1–5 119 (5.3) 2,249 (12.4) 4.4 (3.4–5.6)
5.1–10 167 (19) 880 (4.8) 18.30 (14.50–23.01)
>10.1 238 (43.6) 546 (3) 60.3 (47.8–75.9)
Unknown
83
3,745
NA

Hemoglobin, g/dL
>12 125 (2.7) 4,616 (49.6) 1 <0.0001
10.1–12 76 (2.8) 2,727 (29.3) 1.02 (0.70–1.40)
8.1–10 64 (4.6) 1,377 (14.8) 1.7 (1.3–2.4)
<8 65 (10.9) 591 (6.3) 4.4 (3.2–6.1)
Unknown
502
12,577
NA

Platelet count, × 109/L
>50 132 (1.6) 8,176 (86.9) 1 <0.0001
26–50 88 (9.9) 889 (9.5) 6.7 (5.1–8.8)
11–25 96 (32.6) 294 (3.1) 29.6 (21.9–39.8)
<10 24 (53.3) 45 (0.5) 69.6 (37.8–128.2)
Unknown
492
12,484
NA

Leukocyte count, × 109 cells/L
6–10 250 (2.9) 8,418 (92.4) 1 <0.0001
10.1–15 37 (6.7) 550 (6.1) 2.3 (1.6–3.4)
>15 25 (17.7) 141 (1.5) 7.1 (4.5–11.1)
Unknown 520 12,779 NA

*N = 21,888. NA, not applicable.
†Appropriate chemoprophylactic drugs were mefloquine, atovaquone-proguanil,doxycycline, and chloroquine-proguanil.
‡According to national recommendations, inappropriate chemoprophylactic drugs were chloroquine, proguanil, pyrimethamine, and sulfadoxine- pyrimethamine.

Main Article

1Additional members of the French National Reference Center for Imported Malaria Study Group who contributed data are listed in the Technical Appendix.

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