Malaria in Rio de Janeiro State

Background: Rio de Janeiro is the third most populous Brazilian state and the largest international tourist destination in the entire Southern Hemisphere. Although Rio de Janeiro cityis located in the tropics, there is no malaria transmission. Imported malaria in travellers however, frequently occur and autochthonous malaria cases known as the "bromeliad-malaria" are reported in areas within the Atlantic Forest. Methods: Descriptive study of patients with malaria diagnosis notified from January 2015 to December 2016 in the Rio de Janeiro State, considered a non-endemic malaria area. Results: In the last two years (2015/2016) 106 malaria cases were notified in the State. The Plasmodium species diagnosed in order of frequency were: Plasmodium vivax (63%); P. falciparum (43%); P. malariae (2%) and P. ovale (1%). Most of the cases (n=59, 56%) occurred in travelers coming from known international endemic areas, as African sub-saharam Continent (n=36) what explains the high incidence of P. falciparum when compared to endemic parts of Amazon (Brazil, Peru, Venezuela and Guiana). Autochthonous cases (n=47, 44%) correspond to patients with history of travel to different areas of preserved Atlantic Forest inside the Rio de Janeiro State. From the total cases (106), 76 (72%) were diagnosed, treated and followed in Fiocruz, outpatient clinic, the reference for malaria and other Tropical diseases inside the city of Rio de Janeiro that provides prompt diagnostic tests and infectious diseases consultants for febrile travelers. The majority of patients (60%) report previous appointments in other health units without malaria diagnosis being even considered, 55% of patients’ report being diagnosed as Dengue cases based on clinical findings. Conclusion: Despite been considered a non-endemic area of transmission, RJ city is an important route of tourism and cases of malaria in travelers may occur without specific symptoms leading to misdiagnose and treatment delay. Due to recent rise in the number of cases coming from Atlantic Forest region, clinical suspicion is important even when febrile patients do not come from highly endemic areas.