Investigation and treatment of imported malaria in non-endemic countries

Every year, several thousand people with malaria arrive in non-endemic countries, and about 1600 arrive in the United Kingdom alone. Case fatality in the UK, as elsewhere, is around 1% overall but varies by age and previous exposure to malaria.1 2 3 This rate is similar to that seen in endemic countries, but the age profile of deaths is very different. In Africa mortality is highest in young children, but in imported cases it is highest in older patients, especially those over 65 years.4 5 6 If malaria is treated early, with widely available drugs before it becomes severe, death is avoidable and a full recovery almost guaranteed. Late presentation carries a higher risk of death. The management of severe malaria is a medical emergency. This review describes how to recognise and diagnose malaria, the current treatment of uncomplicated malaria, and the management of patients with severe disease. It concentrates on adults and recent advances relevant to non-endemic high resource countries such as Europe and North America. Different challenges arise in low resource endemic settings and are not covered in this review.