4 Discussion
Malaria is mainly brought over to Homburg by
local travelers coming back from tropical and
subtropical regions. Most malaria patients in
this study were infected with a singlePlasmo-
dium species. One patient with malaria who had
recently traveled was infected by twoPlasmo-
diumspecies:Plasmodium falciparumandPlas-
modium malariae. The prevalence of mixed
malaria infections was just low, which is in line
with other reports on the subject (Mehlotra
et al. 2000 ; Snournou et al. 1993 ). These findings
propose that mixedPlasmodiumspecies malaria
infections are not the usual occurrence in
travelers arriving from regions with malaria
epidemics.
In the present study, a continuous increase in
the amount of malaria cases was not observed nor
was there a clear time trend over the years. The
mean age of patients with malaria was 42 years.
Most malaria cases came from Africa, specifi-
cally from Ghana, andPlasmodium falciparum
was the most often infection agent encountered,
which in line with other studies (Leder
et al. 2004 ). Most malaria patients were German
travelers to long haul destinations. We noted no
malaria-related deaths. Many patients with
malaria did not use pharmacological prophylaxis
and some of those who did also contracted the
disease, which might be caused by the unfinished
course of treatment. An increased serum CRP
level and thrombocytopenia were the most sig-
nificant laboratory features in malaria patients,
which is in line with the study of Epelboin
et al. ( 2013 ). For comparison, the Robert Koch
Institute, where the central database for malaria
exists for statistical analysis in Germany, has
reported that there is no clear time trend in
malaria cases from 1993 to 2003 (Sch€oneberg
et al. 2005 ). However, this institute has reported
that the percentage of cases in persons aged
40–49 has, in general, increased over time and
the greatest malaria frequency has been those
aged 20–39. Most cases of malaria has come
from Africa, Asia, Central America, and South
America andPlasmodium falciparumhas been
the prevalent infectious species. Further, most
malaria patients (60 %) were German travelers
who had gone overseas on holidays or to study.
Most malaria sufferers did not prophylaxis and
more than 20 deaths from malaria were reported
in 1999 (Sch€oneberg et al. 2001 ).
The most common travel-related diseases are
gastrointestinal, febrile, and dermatologic. A
fever in returning travelers necessitates immedi-
ate attention, as it could be the appearance of a
quickly progressing and deadly infectionTable 6 (continued)
Malaria (n¼15) (%) No malaria (n¼38) (%) p-value
State after malaria tropica 0 1 (2.6) 0.526
State after nasal septum surgery 1 (6.7) 0 0.108
State after prostate surgery 0 1 (2.6) 0.526
State after dysentery 0 1 (2.6) 0.526
State after tuberculosis 0 1 (2.6) 0.526
Thrombosis 0 1 (2.6) 0.526Table 7 Malaria medication treatment and prophylaxis in patients (n) (%)
Antimalarial medication (n¼15) (%) p-value 95 % CI
Atovaquone/Proguanil 9 (60.0) <0.0001 0.4–0.8
Mefloquine 4 (26.7) 0.031 0.1–0.5
Quinine 2 (13.3) 0.667 0.04–0.4
Malaria prophylaxis
Chemoprophylaxis 10 (66.7) 0.670 0.01–0.3
No chemoprophylaxis 5 (33.3) 0.670 0.01–0.3Rarity of Mixed Species Malaria withPlasmodium falciparumand... 43