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

qualitative PCR for hepatitis C, qualitative PCR
for hepatitis B if a result of quantification HBeAg
and anti-HBeAg was positive, or antibodies
against hepatitis E if HBV or HCV PCR was
negative.
Next, written informed consent was obtained
from all participants to perform a test for the
detection of human immunodeficiency virus
(HIV). Antibodies against HIV-1, HIV-2, and
p24 antigen were investigated by ELISA test in
the serum collected with Monovette®4.7 mL
(brown top).

2.7 Statistical Elaboration

Categorical data are expressed in proportion,
while continuous data are expressed as means
standard deviations (SDs). Calculations were
performed at a 95 % confidence interval
(CI) for the total number of patients with malaria
and for the comparison of the use and non-use of
antimalarial chemoprophylaxis. A chi-squared
test for two independent variables of two
probabilities was carried out for gender differ-
ence. This test was also used for statistical com-
parison of symptoms; locals and foreigners;
outpatients and inpatients; and comorbidities
between the patients with and without malaria.
One-way analysis of variance (ANOVA) for
independent samples was performed to compare
mean age, duration of hospital stay, and labora-
tory values between the two groups. The null
hypothesis in the study was that there would be
no differences for the type of malaria, antimalar-
ial medication, and time trends of malaria. The

tests were two-tailed, and a p-value of<0.05

was considered statistically significant.

3 Results

In the hospital database, 53 patients were found

who had been examined for malaria during the

study period of 2004–2012. In total, 15 patients

(28.3 %, three females [20 %]; 95 % CI,

0.2–0.4) were diagnosed with malaria. There

were no differences in gender and age between

the patients with and without malaria (Table1).

The patients with malaria were treated as

inpatients, and those without malaria were

treated as outpatients (p¼0.01). There was no

difference in the duration of hospitalization

(Table 1). Notably, there was a significant

increase in malaria cases in 2009 (p¼0.031).

However, a continued increase in malaria preva-

lence was not observed during the study period

(Fig. 1). Malaria caused by Plasmodium

falciparumwas the most common form of the

disease noted in Homburg and the surrounding

province of Saarland (p<0.0001) (Table 2).

One patient (6.7 %) had a mixed malaria infec-

tion from two species of malaria parasite,Plas-

modium falciparumandPlasmodium malariae,

in the blood smear and PCR diagnosis

(p¼0.670). Thrombocytopenia and enhanced

level of CRP were the dominant laboratory

findings (Table3), and fever was the leading

clinical symptom in the patients with malaria

(p¼0.031) (Table 4), Malaria was mainly

brought over by locals to Homburg from long

haul destinations (p¼0.009), mainly from

Ghana. In contrast, no malaria cases were

Table 1 Basic demographic and hospital data of patients with and without malaria

Malaria (n¼15) (%) No malaria (n¼38) (%) p-value
Male 12 (80.0) 30 (79.0) 0.932
Female 3 (20.0) 8 (21.1) 0.932
Locals 8 (53.3) 33 (86.8) 0.009
Foreigners 7 (46.7) 5 (13.2) 0.009
Mean age (year)
SD 42.3
16.5 44.5
18.6 0.691
Length of hospital stay (days)
SD 6.3
8.3 3.3
9.4 0.291
Outpatients 4 (26.7) 25 (65.8) 0.010
Inpatients 11 (73.3) 13 (34.2) 0.010
SDstandard deviation

Rarity of Mixed Species Malaria withPlasmodium falciparumand... 39