Volume 17, Number 5—May 2011
CME ACTIVITY - Research
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 Durand
, and for the French National Reference Center for Imported Malaria Study Group
, and for the French National Reference Center for Imported Malaria Study Group
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.
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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