We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Imported Malaria Clinical Presentation and Examination of Symptomatic Travelers

James E. Svenson, MD, MSc; J. Dick MacLean, MD; Theresa W. Gyorkos, PhD; Jay Keystone, MD
Arch Intern Med. 1995;155(8):861-868. doi:10.1001/archinte.1995.00430080109013.
Text Size: A A A
Published online


Background:  The diagnosis of malaria in nonendemic countries presents a continuing challenge. Increasing physician awareness of the variability in its clinical presentation will improve clinical management and health out Methods: Charts of patients in whom malaria was diagnosed at two hospital-based tropical disease centers between September 1,1980, and December 31,1991, were reviewed.

Results:  Of a total of 482 cases, 182 were caused by Plasmodium falciparum and 246 by Plasmodium vivax. Fifty-two patients with P falciparum malaria were hospitalized; 13 were classified as having severe falciparum malaria. Nineteen patients with P vivax malaria required hospitalization. The only death was caused by P vivax. Chemoprophylaxis was used by, or prescribed for, 46% of patients; however, of these, only half were compliant in taking their medication. Eighty-seven percent of patients with falciparum malaria presented within 6 weeks of return from travel to an endemic area. One third of patients with P vivax malaria presented more than 6 months after travel. The average time between onset of symptoms and physician contact was 6.7 days. Diagnosis was often delayed in those who sought care outside the referral center. Almost all patients had a history of fever, but only half were febrile at presentation. Presenting symptoms and signs were nonspecific. Fifty percent of patients were thrombocytopenic. Other laboratory abnormalities were mild.

Conclusions:  Since the presentation of malaria is vague and nonspecific, the diagnosis should be considered in any appropriately symptomatic patient with a history of travel to a malaria-endemic area, and appropriate testing should be done. Up-to-date information on chemoprophylaxis should be provided to all travelers to malariaendemic regions.(Arch Intern Med. 1995;155:861-868)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

96 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.