Clinicoepidemiological study of imported malaria in travelers and immigrants to Madrid.

Background: The number of Spanish travelers visiting malaria endemic areas, and the number of immigrants from malarial countries arriving in Spain are continuously increasing. However, little information about imported cases in Spain is available. Methods: A prospective clinicoepidemiological study of imported cases of malaria diagnosed at a referral teaching hospital in Madrid, Spain. Results: Of the 160 patients, sixty (37.5%) were immigrants and 100 (62.5%) Spanish nationals. Malaria was acquired in Africa by 98.3% of immigrants and in 83.0% of travelers. Falciparum malaria accounted for 71.8% of the cases, P. vivax for 11.9%, P. ovale for 10.6% and P. malarie for 5.0%. Eleven (6.9%) patients, all immigrants, were asymptomatic. Severe complications were recorded in 17 (10.6%): 7, severe anemia; 3, cerebral malaria; 2, renal failure; 1, spontaneous splenic rupture; 1, acute pulmonary edema; 1, sepsis; 1, acute cerebrovascular accident; and 1, disseminated intravascular coagulation. There were no fatal cases. Among the 100 Spanish nationals, 44% did not follow any prophylaxis, 29% followed a correct prophylaxis, 27% were considered defaulters, and 39% took self-treatment without cure. Conclusions: There is a changing pattern of imported malaria in Madrid, with one third occurring in immigrants and two thirds in nationals. This data provides information about the reemergence of imported malaria to Europe.