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Epidemiological and clinical characteristics of imported falciparum malaria in the Republic of North Macedonia

A 13-year experience

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Summary

Background

Plasmodium falciparum is the leading cause of imported malaria and the most common cause of death in returning travellers.

Aim

To identify the main epidemiological and clinical characteristics of patients with imported falciparum malaria in the Republic of North Macedonia.

Material and methods

Retrospectively analyzed were the epidemiological and clinical features of 34 patients with imported falciparum malaria who were diagnosed and treated at the university clinic for infectious diseases and febrile conditions in Skopje from 2010 to 2022. Malaria diagnosis was based on the microscopic detection of parasites in thick and thin blood smears.

Results

All patients were male, with a median age of 36 years and a range of 22–60 years. Of the patients 33 (97.1%) acquired the disease in Sub-Saharan Africa. All patients except one stayed in endemic regions for work/business purposes. Chemoprophylaxis was completely applied in 4 (11.8%) patients. The median time of onset between the symptoms and diagnosis was 4 days, with a range of 1–12 days. Prevailing clinical manifestations were fever, chills, and splenomegaly in 100%, 94%, and 68% of patients, respectively. Severe malaria was noticed in 8 (23.5%) patients. In 5 (14.7%) patients the initial parasitemia was higher than 5%. On admission, thrombocytopenia, hyperbilirubinemia, and elevated alanine aminotransferase were registered in 94%, 58%, and 62% of patients, respectively. Out of the 33 patients with adequate follow-up, the outcome was favorable in 31 (93.9%).

Conclusion

In every febrile traveller returned from Africa, imported falciparum malaria should be an essential part of differential diagnostic considerations.

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Authors and Affiliations

  1. University Clinic for Infectious Diseases and Febrile Conditions, Medical Faculty, University Ss.Cyril and Methodius in Skopje, Skopje, Republic of North Macedonia

    Mile Bosilkovski M.D., PhD, Kostadin Poposki M.D., Vesna Semenakova-Cvetkovska M.D., Ivan Vidinic M.D., Arlinda Osmani Lloga M.D., Dejan Jakimovski M.D. & Marija Dimzova M.D., PhD

  2. Department of Biology, Faculty of Natural and Life Sciences, University of El Oued, PO Box 789, 39000, El Oued, Algeria

    Bachir Khezzani PhD

  3. Laboratory of Biology, Environment and Health (LBEH), Faculty of Natural and Life Sciences, University of El Oued, PO Box 789, 39000, El Oued, Algeria

    Bachir Khezzani PhD

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  1. Mile Bosilkovski M.D., PhD
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Contributions

Mile Bosilkovski: concept, design, acquisition of data, interpretation of data, drafting the article, final approval of the version to be submitted. Bachir Khezzani: design, revising the article critically for important intellectual content, drafting the article, final approval of the version to be submitted. Kostadin Poposki: acquisition, analysis, and interpretation of data, final approval of the version to be submitted. Vesna Semenakova-Cvetkovska, Ivan Vidinic, Arlinda Osmani Lloga, Dejan Jakimovski, Marija Dimzova: acquisition, analysis, and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be submitted.

Corresponding author

Correspondence to Bachir Khezzani PhD.

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Conflict of interest

M. Bosilkovski, B. Khezzani, K. Poposki, V. Semenakova-Cvetkovska, I. Vidinic, A.O. Lloga, D. Jakimovski and M. Dimzova declare that they have no competing interests.

Ethical standards

The study was approved by the Ethics Committee of the Faculty of Medicine in Skopje. The study was conducted in accordance with the ethical principles for medical research in humans and the Declaration of Helsinki. However, written informed consent was waived given its retrospective observational design.

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Bosilkovski, M., Khezzani, B., Poposki, K. et al. Epidemiological and clinical characteristics of imported falciparum malaria in the Republic of North Macedonia. Wien Klin Wochenschr 135, 609–616 (2023). https://doi.org/10.1007/s00508-023-02192-6

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