Imported malaria in an italian paediatric department, 1996-2012

Imported malaria is progressively increasing in Italy in the last two decades. A significant number of malaria cases is registered every year in North-eastern Italy due to the high immigration rate. Most cases are non - immune African children born in Italy and visiting friends and relatives (VFR) in endemic areas without proper chemioprophylaxis. We described 65 paediatric cases of imported malaria (age range: 7 mo-15 yrs),admitted to our Paediatric Department during the period 1996-2012. 39 (60%) were long-term immigrants VFR, 24 (38%) were new immigrants arriving in Italy for the first time, 1 was Indian adopted child and 1 an Italian child visiting Africa with parents for tourism. 64 children came back from Sub-Saharan Africa, while only one child came from Asia. Non-appropriate prophylaxis was reported in all cases. Up to 2009 Plasmodium falciparum was the only isolated parasite while, during the last 3 years, 7 cases of mixed malaria (P. falciparum, P. ovale, P. malariae and P. vivax) were observed. All the cases were treated with quinine and since 2011 with Artemisinin derivatives, according to WHO Guidelines. All patients survived, nobody reported neurological sequelae. We emphasize a case of severe malaria complicated with rhabdomyolysis and acute renal failure due to delayed diagnosis. These epidemiological data demonstrate how important should be the information about chemoprophylaxis in long-term immigrants in order to prevent imported malaria. Early diagnosis of malaria reduces severe complications: we recommend physicians to suspect this infection in all febrile children coming from malaria endemic areas.