Abstract:
An increase in the number of imported parasitic infections in children could be expected due to the increase in travel to subtropical and tropical countries as well as migration from these regions. Precautions such as malaria prophylaxis are recommended before journeys to the particular endemic areas, but it is not known how widely this advice is taken and what influence this has on parasitic infections in children in Germany. Using the results of a 2-year study, the work presents, discusses, and analyzes the data concerning the most important parasitic diseases, malaria, visceral leishmaniasis and schistosomiasis, that are associated with considerable health problems and are the most common worldwide, in children in Germany.
An anonymized questionnaire was used by ESPED (Erhebungseinheit für seltene pädiatrische Erkrankungen im Kindesalter, Registry for rare pediatric illnesses during childhood) from July 2001 to June 2003 to collect data about imported malaria, schistosomiasis, and visceral leishmaniasis in children being treated as inpatients in children’s clinics. The data were tested for their significance using the statistical package SAS. The children were grouped according to their ethnic background as immigrants, children from immigrant families, or Caucasian children.
During the time period mentioned above, 92 children imported confirmed cases of malaria into Germany. Of these, 66 cases were of Malaria tropica, 17 cases were of Malaria tertiana, one case was of Malaria quartana, and a further case was caused by a double infection of P. falciparum and P. vivax. In 7 cases the species of Plasmodia was not identified. 32 of the children were immigrants, 51 children came from immigrant families, and 9 children had a Caucasian background. In 78 of the cases the malaria was imported from Africa and 56 of these were from West Africa. 88% of all children presented to the physician with fever, 67% showed general symptoms, and 57% complained of gastrointestinal problems. Apart from parasitemia of up to 28% parasites/µl, the following abnormal laboratory findings were seen at diagnosis: anemia in 43%, thrombocytopenia in 53%, and C-reactive protein in 82.5%. Using the WHO criteria, 22 children were diagnosed with a severe Malaria tropica, 14 of those due to hyperparasitemia (>5% parasites/µl). 65 of the children received treatment according to the guidelines of the DTG (Deutsche Gesellschaft für Tropenmedizin e.V., German Society of Tropical Medicine), 28 children had side effects. There were no deaths. There were no differences between the groups of children in terms of the aspects studied such as symptoms, laboratory parameters, and disease progression, with the exception of general symptoms. Travel advice was taken more frequently by Caucasian children than children from immigrant families, and the latter spent more time in the endemic region. 3 children with visceral leishmania and 4 children with schistosomiasis were treated as inpatients.
The comparison of the individual groups of children shows that the majority of malaria cases are imported by children from immigrant families or by immigrants. The former are the group most at risk for having malaria in Germany and therefore need special schooling, explanation, and support. Because the incidence of malaria imported by children to Germany remained unchanged during the observation period, the study does not show evidence of a necessity to change the DTG recommendations from 2001 on malaria prophylaxis for children. The very few reported cases of visceral leishmaniasis and schistosomiasis only allow a limited analysis of their import into Germany during childhood.