Difficulties in the Prevention, Diagnosis, and Treatment of Imported Malaria

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Abstract
MALARIA REMAINS one of the most important infectious diseases in the world.1 An estimated 300 to 500 million cases occur each year, causing 1.5 to 2.7 million deaths.2 In the United States, the incidence of imported malaria began to rise in the 1970s, and recent reports have documented well over 1000 cases per year.3 These reports likely understate the true incidence of malaria, as it is estimated that 40% to 70% of cases are not reported.4-6 Many cases of imported malaria appear to be preventable, as travelers often fail to follow appropriate guidelines for prevention,7-11 and this failure has been associated with an increased risk for malaria.12 Delays in diagnosis and therapy have also been common7,8,10 and have been associated with increases in morbidity and mortality.8,13,14

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