Pre-diagnosis treatment with antimalarial medications, or with medications having partial activity against Plasmodium species (such as azithromycin) occurred in 31% of patients. One patient, with travel to Africa, was empirically prescribed chloroquine by a U.S. physician to treat a suspected Plasmodium falciparum infection, three patients were taking azithromycin for presumptive respiratory tract infections,

and the remaining patients were either empirically self-treating with medications purchased off the shelf in Africa, or were prescribed antimalarials by a physician in Africa. Chloroquine and sulfadoxine pyramethamine were most common. There were no deaths in the study population. One patient experienced cardiac arrest Selleck Staurosporine but survived. Another patient (newly arrived from a Liberian refugee camp) had a sibling that died at home 1 week before presenting; details of that out-of-hospital death were not available. Malaria was

accurately diagnosed on the day of initial presentation for 82% of the 92 patients for whom this information was available for review. At least three patients who were given their first treatment dose in the emergency department and then managed as outpatients were subsequently admitted after clinically worsening following failed attempts to fill their prescriptions at local pharmacies. Two patients were treated with exchange transfusions. Clinical and epidemiological Roxadustat concentration analysis of the CNMC cohort did not find statistically significant indices of risk such as age, gender, purpose of travel, or pre-treatment with antimalarial medications for accurately predicting who, at the time of presentation, was at risk of severe malaria or to require hospitalization. A total of 306 inpatient cases for which malaria was the primary diagnosis were obtained Protein tyrosine phosphatase from the PHIS database. Epidemiology and clinical findings from the PHIS hospitals compared to CNMC PHIS data during the same time period is summarized in Table 3. The CI for the entire dataset was 1.2 per 10,000 patient admissions [95% CI 1.1–1.3]. Of the 306 inpatient cases, 67% (n = 205) were of black race. Plasmodium falciparum infection was seen in 52% (n = 160)

of patients, and 39% had an unspecified species. Unspecified species may reflect coding variation in the database as opposed to the actual diagnosis and clinical management. Patients of black race comprised three-quarters of all P. falciparum cases (n = 119, 74%); however, all other races combined experienced the greatest number of non-P. falciparum infections (n = 22, 79%). As was seen at CNMC, the peak of malaria cases occurred in the summer months of July, August, and September, with a lower, secondary peak of malaria occurring in January. The hospital charges incurred by the 306 cases totaled US $5,360,951. Crude mean charges equaled $17,519 [95% CI $1,149–718,956; SD ± 46,346] with crude average daily charges equal to $4,247 [SD ± 2,459]. By malaria type, charges for P.