Respiratory Treatment and Prevention (Advances in Experimental Medicine and Biology)

located in the province of Saarland in western
Germany, with a population of 44,000. The Uni-
versity of Saarland Medical Center is the main
reference place for infectious diseases in the area
and it treats patients with malaria. This investi-
gation also examined the variation in clinical
symptoms of patients with malaria, as well as
the treatments and outcomes.

2 Methods

All of patients’ data were anonymized prior to
analysis. The Medical Association of Saarland’s
Institutional Review Board approved this study.
The requirement for written, informed consent of
patients was waived because of the retrospective
nature of the analysis of medical records.

2.1 Patients

This unmatched case-control study retrospec-
tively examined the whole data from all patients
who had been tested for malaria, using hospital
chart data from the Department of Internal Med-
icine, Saarland University Medical Center, dur-
ing the period of 2004–2012. The data included
age, gender, race, duration of hospitalization,
outpatient or inpatient status, laboratory values,
discharge diagnosis from the local hospital, and
current and previous diseases from questioning
the personal history of the patient.

2.2 Case-Control Study

Malaria cases and controls were identified by a
process of passive case detection in which
outpatients with febrile illness were examined
for malaria. The case definition included those
with clinical symptoms of malaria, such as a
body temperature> 37 C, history of fever,
headache, or body ache, who tested positive for
malaria parasites by microscopy. Individuals
with febrile illness shown by microscopy to be
malaria-negative were identified as controls.

The diagnosis of co-morbidities was also car-

ried from the hospital charts, medical history, or

during the current investigation newly discov-

ered diseases. Comorbidities were diagnosed

after clinical symptoms and confirmed by instru-

mental and laboratorial examinations. The pro-

cess of data collection was the same for cases and

controls. The selection of cases and controls was

made independently using hospital chart data,

and individual matching was not undertaken.

2.3 Inclusion and Exclusion Criteria

The inclusion criteria were the following:

patients with unclear fever who had recently

returned from a malaria-endemic area or any

patient whose doctor considered malaria as a

differential diagnosis. The study population

consisted of patients diagnosed with malaria

after malaria parasites or antigens were identified

in the patient’s blood. The control group

consisted of patients in whom malaria was

excluded. Age and sex differences were com-

pared between patients with and without malaria.

This study examined whether malaria was more

common in the local German population or in

foreigners. Additionally, as malaria is known to

be a tropical and subtropical infectious disease,

the travel destination as a possible source of

infection was investigated (Behrens and Alexan-

der 2013 ).

All patients under 18 years of age who were

detected to have malaria were excluded from the

study. Patients examined at the Department of

Neurology who were suspected of having

malaria were also excluded from this study

because of restricted access to their medical

records.

2.4 Symptoms and Diagnosis

of Malaria

Early symptoms of malaria are nonspecific and

diverse, such as fever, headache, weakness,

myalgia, chills, dizziness, abdominal pain, diar-

rhea, nausea, vomiting, anorexia, and pruritus

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