Severe imported Plasmodium falciparum malaria in children: characteristics and useful factors in the risk stratification

Background: Severe imported pediatric malaria is of concern in non-endemic settings. We aimed to determine the features of pediatric severe cases in order to design a model able to stratify patients at presentation. Methods: We conducted a retrospective cross-sectional study including all imported P. falciparum malaria infection in patients ≤14 years of age, treated from January 2008 to February 2019 in two tertiary hospitals: Brescia, Italy and Barcelona, Spain. Severe malaria was defined according to World Health Organization criteria. Mortality rate, pediatric intensive care unit (PICU) stay and blood transfusion were analysed as adverse outcomes. Results: Out of 139 children included, 30.9% were severe malaria. Twenty-seven (19.4%) were admitted to PICU, and transfusion was required in 14 cases (10.1%). Predictors for severe malaria were: young age, low hemoglobin, high white blood cells (WBC) and high C-reactive protein. Platelet <130,000/μl correlated with severe malaria (without statistical significance). A model that includes age, WBC and C-reactive protein shows a high specificity to classify patients without severe malaria (92.3%) with 70% PPV and 75% NPV. Conclusions: A score based on patient's age, WBC and C-reactive protein easily available at emergency room can help to identify children with higher risk of adverse outcomes.