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

(Burchard 2014 ). The diagnostics for the febrile
patient should be stepwise and take into account
the patient’s travel history and experience.
Malaria is the most common cause of fever in
patients returning from tropical and subtropical
areas. This observation was also confirmed in the
present study, where most patients diagnosed
with malaria presented with fever. However, it
is unclear if the most common cause of fever in
returning travelers is malaria infection. Severe
cases of malaria, with patients staying in the
intensive care unit, have poor outcomes (Corne
et al. 2004 ). Such cases of malaria were not
observed in the present study, although most
patients with malaria were hospitalized. All
malaria patients should be hospitalized within
24 h (Lalloo et al. 2007 ) and treated in a
specialized department of a hospital (Marks
et al. 2014 ).
Numerous antimalarial medications exist for
chemoprophylaxis in case of traveling to a
malaria-endemic country or for treating a patient
with malaria. The selection of the most suitable
medication should be influenced by contrain-
dications and indications for each drug, princi-
pally subordinated to the existence and level of
Plasmodium falciparumchemosensitivity in the
region where the infection originated. For pre-
vention, chloroquine alone can be considered for
visitors to regions wherePlasmodium falciparum
is rare or not chloroquine resistant. For other
regions, selection of chloroquine and proguanil
or mefloquine varies depending on the frequency
ofPlasmodium falciparumand its level of resis-
tance to chloroquine (Bourgeade and Delmont
1998 ). For treatment, the only indications for
chloroquine are malaria cases brought over
from faraway destinations due to eitherPlasmo-
dium vivax,Plasmodium ovale,orPlasmodium
malariaeor affected byPlasmodium falciparum
contracted in one of the few nations where this
type is still responsive to chloroquine. For
non-severe Plasmodium falciparum malaria
developed in a chemo-resistant zone, meflo-
quine, halofantrine, sulfadoxine-pyrimethamine,
or oral quinine is prescribed, depending on the
suitable chemoprophylaxis, contraindications,
and doubt of chemo-resistance. Irrespective of

the region of origin,Plasmodium falciparumin

a patient with severe symptoms or heavy

vomiting, is treated by intravenous quinine,

associated with tetracycline if the patient arrives

from a zone that is known for little quinine sen-

sitivity of this species (Bourgeade and Delmont

1998 ). In the present study, mefloquine was

employed for treatment of most malaria patients,

and a combination treatment with atovaquone

and proguanil was employed in a few most

severe cases. The antimalarial medications pre-

scribed most often in another study have

consisted of atovaquone and proguanil

(Bloechliger et al. 2014 ). Mefloquine is fre-

quently prescribed for children and pregnant

women; however, it is rarely prescribed for

patients with comorbidities considered as

contraindications. A combination of chloroquine

and proguanil is less efficient compared with

mefloquine, but that of atovaquone and proguanil

is at least as effective as mefloquine, although

disease progression may take place (Kofoed and

Petersen 2003 ). However, there are discrepancies

in treatment outcomes among studies. Jacquerioz

and Croft ( 2009 ) have reported that atovaquone-

proguanil and doxycycline are the top tolerated

medications, and mefloquine is linked with

neuropsychiatric adverse outcomes. Siikama ̈ki

et al. ( 2013 ) have found that mefloquine,

atovaquone and proguanil, and doxycycline are

efficient as a means of chemoprophylaxis against

Plasmodium falciparummalaria, when properly

employed.

5 Conclusions

Patients with a fever after returning from Africa

should be subjected to a malaria test. Malaria

caused byPlasmodium falciparumis the most

common form of disease brought over to

Saarland province in Germany by local travelers

to Africa and other long haul destinations.

Mixed-species Plasmodium falciparum and

Plasmodium malariaeare uncommon in malaria

in travelers. Fever, thrombocytopenia, and ele-

vated CRP are the leading features of malaria.

Malaria prophylaxis is recommended as a

44 J. Yayan and K. Rasche