Management of malaria in Sweden.

Malaria is a potentially severe infection and time to treatment can be decisive for the outcome. Febrile patients returning from travel in endemic areas should therefore be promptly investigated for malaria. This review focuses on the acute management of malaria in Sweden. The disease is diagnosed in travellers, migrants and temporary visitors from malaria-endemic countries. Malaria is a relatively rare infection in Sweden, with approximately 150 imported cases per year in a population of 10 million. Health care delay is a risk of more severe disease. Children, pregnant women, elderly, and individuals from endemic areas who lived in Sweden for a long time as well as those with comorbidities are at increased risk of severe malaria. Microscopy is used for diagnosis and determination parasite density; rapid diagnostic tests are supportive diagnostic tools. First-line treatment for severe malaria is intravenous artesunate and for uncomplicated P. falciparum malaria artemether-lumefantrine (AL) or chloroquine in cases with non-P. falciparum infections from areas without known resistance. Treatment failures have been observed in non-immune travelers treated with AL, and patients should be recommended to seek care in the event of new fever. Being a relative rare disease in Sweden, management of malaria is performed at specialized centers with infectious disease specialists.