Primaquine plus clindamycin as a promising salvage therapy for Pneumocystis jirovecii pneumonia: A retrospective analysis in Japanese patients.

Treatment of intractable Pneumocystis jirovecii pneumonia (PCP) patients with primaquine (PQ) in combination with clindamycin (CLDM) was conducted by the Research Group on Chemotherapy of Tropical Diseases (RG-CTD), as a kind of compassionate use. Primaquine was not nationally licensed at the time but imported by RG-CTD for the use in a clinical research to investigate safety and efficacy in malaria treatment. Eighteen Japanese adult patients thus treated were analyzed. Prior to the treatment with PQ-CLDM, most of the patients had been treated with trimethoprim-sulfamethoxazole first, all of which being followed by pentamidine and/or atovaquone treatment. This combination regimen of PQ-CLDM was effective in 16 (89%) patients and developed adverse events (AEs) in five (28%) patients. AEs included skin lesions, methemoglobinemia, and hepatic dysfunction, though none of them were serious. As a second-line or salvage treatment for PCP, PQ-CLDM appears to be a better option than pentamidine or atovaquone. Currently in Japan, both PQ and CLDM are licensed drugs but neither of them is approved for treatment of PCP. Considering the potentially fatal nature of PCP, approval of PQ-CLDM for treating this illness should be urged.

Severe delayed haemolytic anaemia associated with artemether-lumefantrine treatment of malaria in a Japanese traveller.

Delayed haemolytic anaemia has been reported in association with intravenous artesunate treatment in patients with severe Plasmodium falciparum malaria, and furthermore, oral artemisinin-based combination therapies including artemether-lumefantrine (AL) have also been incriminated. However, definite cases of delayed haemolytic anaemia associated with AL appear to be scarce, as reported cases were often treated concomitantly with other anti-malarials. In this study, we report a severe case of delayed haemolytic anaemia following AL alone in a Japanese traveller with severe parasitaemia caused by numerous P. falciparum parasites and a few P. vivax parasites. We also stress the need by further studies to differentiate between delayed haemolytic anaemia and blackwater fever, the latter being another malaria-related haemolytic condition, more clearly than they are now.

Imported malaria in pregnant women experienced in Japan.

INTRODUCTION: With ever-growing global exchanges, the number of travelers, including pregnant women, to the tropics is increasing, which poses a risk of contracting malaria. Although there are several reports on imported malaria in pregnancy from Western countries, those focusing on cases experienced in Japan are very limited. METHODS: We searched for cases of malaria in pregnancy in the treatment records submitted to the Research Group on Chemotherapy of Tropical Diseases, Japan, during the period 1993-2016. Literature searches were also conducted using an American and a Japanese search system. RESULTS: Ten cases of malaria in pregnant women were identified, including four cases with Plasmodium falciparum. Of eight evaluable cases, only one practiced malaria chemoprophylaxis. Among the nine evaluable cases, eight resulted in uneventful delivery and one P. falciparum case developed severe hepatic disturbance, disseminated intravascular coagulation, and intrauterine fetal death. After the initial attack, none of the Plasmodium vivax/Plasmodium ovale cases practiced chloroquine prophylaxis until delivery. One P. ovale case received a lower dose regimen of chloroquine as acute-stage therapy. CONCLUSION: This study demonstrated additional cases of imported malaria in pregnant women to the literature and highlighted various epidemiological, demographic, and clinical characteristics. Some of the clinical issues raised need to be investigated. Due to the paucity of the cases worldwide, sharing information among various countries is indispensable, and international guidelines which are now increasingly recommending the use of artemisinins in pregnant women should be referred.

[Pharmacotherapy of parasitic and tropical diseases in Japan].

Parasitic and tropical diseases are relatively rare in Japan. However, physicians have to realize that a patient may visit your hospital today, who is infected with a potentially fatal parasite. This review focuses on the treatment of the domestic and imported parasitic infections in Japan. Many of the drugs against parasitic diseases, especially imported protozoan diseases, have not been approved, nor have been covered by the National Health Insurance Policy. Therefore, patients who need pharmacotherapy with an unapproved drug have to be treated in one of the hospitals of the Research Group on Chemotherapy of Tropical Diseases, which imports effective drugs against major tropical diseases.

Effects of anti-malarial drugs on the electrocardiographic QT interval modelled in the isolated perfused guinea pig heart system.

BACKGROUND: Concern over the potential cardiotoxicity of anti-malarial drugs inducing a prolonged electrocardiographic QT interval has resulted in the almost complete withdrawal from the market of one anti-malarial drug - halofantrine. The effects on the QT interval of four anti-malarial drugs were examined, using the guinea pig heart. METHODS: The guinea pig heart was isolated, mounted on a Langendorff apparatus, and was then perfused with pyruvate-added Klebs-Henseleit solutions containing graded concentrations of the four agents such as quinidine (0.15 - 1.2 µM), quinine (0.3 - 2.4 µM), halofantrine (0.1 - 2.0 µM) and mefloquine (0.1 - 2.0 µM). The heart rate-corrected QaTc intervals were measured to evaluate drug-induced QT prolongation effects. RESULTS: Quinidine, quinine, and halofantrine prolonged the QaTc interval in a dose-dependent manner, whereas no such effect was found with mefloquine. The EC50 values for the QaTc prolongation effects, the concentration that gives a half-maximum effect, were quinidine < quinine ≈ halofantrine. CONCLUSIONS: In this study, an isolated, perfused guinea pig heart system was constructed to assess the cardiotoxic potential of anti-malarial drugs. This isolated perfused guinea pig heart system could be used to test newly developed anti-malarial drugs for their inherent QT lengthening potential. More information is required on the potential variation in unbound drug concentrations in humans, and their role in cardiotoxicity.

Travelers' risk of malaria by destination country: a study from Japan.

BACKGROUND: Country-specific information on the incidence of malaria in travelers provides the most reliable data on which to base the pre-travel risk assessment. Some such studies have been conducted among Western travelers; however, to our knowledge, there have been no reports on Japanese travelers. METHODS: Malaria cases that were diagnosed between April 1999 and December 2005 and were reported to the national infectious disease surveillance body were used as the numerators after grouped into countries of disease acquisition. The denominators, the numbers of Japanese travelers visiting individual countries were derived from the recipient countries and obtained through a Japanese organization. RESULTS: In addition to the well-documented high risks in sub-Saharan countries, our study showed that travelers to Papua New Guinea were exposed to a significantly high risk of malaria. In Asia, Myanmar had the highest risk. Generally, malaria incidence rates among Japanese travelers were lower than those previously reported on Western travelers. However, the rates were rather comparable to the data obtained recently. CONCLUSIONS: These malaria incidence data in travelers should be taken into consideration for pre-travel risk assessment. They need to be constantly updated, and at the same time, limitations in data interpretation that are inherent in various study methodologies should also be clarified.

Knowledge, attitudes, and practices of Japanese travelers towards malaria prevention during overseas travel.

BACKGROUND: There has been some concern that Japanese travelers are not adequately protected against malaria, especially when compared to Western travelers. Multi-national studies of knowledge, attitudes, and practices (KAP) regarding malaria risk have previously been conducted in travelers. METHODS: We conducted a KAP study in Japanese travelers using the same standardized questionnaire as the previous studies. Unlike those studies, questionnaires could not be distributed at departure lounges/gates at international airports, and therefore, travelers were sourced from several different study sites, targeting different populations. RESULTS: A total of 212 Japanese travelers who had visited malarious areas were enrolled, of which 63.2% had visited Asia and 28.3% visited sub-Saharan Africa. Significant shortcomings in KAP were noted with respect to lack of knowledge about symptoms of malaria, poor awareness of malaria risk at their destination, and non-adherence to adequate antimosquito measures. Chemoprophylaxis use was lower among Japanese travelers than travelers from other countries, even when confining to those traveling to sub-Saharan Africa. CONCLUSIONS: Japanese travel medicine providers and general practitioners who engage in pre-travel consultation should raise awareness of travelers about the seriousness of malaria, the need for improved compliance with chemoprophylaxis, and the importance of being properly prepared prior to departure.

Retrospective observational study of the use of artemether-lumefantrine in the treatment of malaria in Japan.

BACKGROUND: The Research Group on Chemotherapy of Tropical Diseases, Japan, introduced artemether-lumefantrine (AL) in late 2002, mainly for treating uncomplicated Plasmodium falciparum malaria. Because AL was on the market in Japan in March 2017, the effectiveness and safety of AL were analyzed to help medical personnel use AL optimally. METHODS: Case report forms submitted by the attending physicians were analyzed. When necessary, direct contact with the attending physicians was made to obtain detailed information. RESULTS: Effectiveness analysis was performed for 62 cases and safety analysis was performed for 66 cases. In P. falciparum malaria, the overall cure rate was 91.1% (51/56), of which the cure rates for Japanese and non-Japanese patients were 82.1% (23/28) and 100% (28/28), respectively. The successfully treated cases included severe P. falciparum malaria, with parasite densities exceeding 500,000/µL. Adverse events were reported in 14 patients, including delayed hemolytic anemia which occurred in the top four highest parasitemic cases. CONCLUSIONS: AL treatment failure in P. falciparum malaria may not be rare among non-immune individuals, including Japanese. The possibility of delayed hemolytic anemia, which occurs preferentially in high parasitemic cases, should be considered following AL treatment.

Experience with intravenous metronidazole to treat moderate-to-severe amebiasis in Japan.

Twenty-eight cases of either intestinal amebiasis, amebic liver abscess, or both, most of which were of moderate-to-severe intensity, were treated with intravenous metronidazole, pioneered by the Research Group on Chemotherapy of Tropical Diseases, Japan. This study was not conducted as a formal clinical trial, and all patients either underwent colectomy for intestinal amebiasis, received oral metronidazole, or both. Despite these limitations, intravenous metronidazole was shown to be well tolerated and seemed to be very effective. This agent should be more widely recommended than previously thought for treating moderate-to-severe amebiasis, especially its intestinal form.

Malaria and mefloquine prophylaxis use among Japan Ground Self-Defense Force personnel deployed in East Timor.

BACKGROUND: Malaria poses a significant threat to military personnel stationed in endemic areas; therefore, it is important to examine the risks of military operations, particularly in areas where malaria-related data are scarce. The recent deployment of Japan Ground Self-Defense Force (JGSDF) for a peacekeeping operation in East Timor provided an opportunity to investigate these risks. The results of these studies may be translated into chemoprophylactic strategies for travelers. METHODS: A total of 1,876 members were deployed between April 2002 and September 2003. They consisted of three battalions; each remained for 6 months and was put on mefloquine prophylaxis. Malaria infection was investigated, including exposure to Plasmodium falciparum sporozoites, assessed by seroconversion for anticircumsporozoite (anti-CS) protein antibodies. Adherence to and adverse events (AEs) of mefloquine were studied via questionnaires. RESULTS: Four members were evacuated: one each with optic neuritis, lung cancer with brain metastasis, IgA nephropathy, and psychotic reactions that may have been precipitated by mefloquine. Six clinical episodes of Plasmodium vivax occurred, including one relapse, but there were no clinical cases of P falciparum, yielding a crude malaria attack rate of 0.32% for the 6-month period. Overall, 3.1% of the study population seroconverted for the anti-CS protein antibodies, with some regional differences noted. About 24% of questionnaire respondents, reported AEs; however, none of the AEs was severe. The AEs tended to emerge during the initial doses of chemoprophylaxis. CONCLUSIONS: The implementation of mefloquine prophylaxis among JGSDF personnel in East Timor, where P falciparum constitutes a moderate risk, appears to have been a success. Mefloquine prophylaxis was generally safe for Japanese unless predisposed to neuropsychiatric illness. However, given that mefloquine is the only chemoprophylactic agent available, a risk-benefit analysis tailored to the traveler is required for visits to countries such as East Timor.

[Evaluation of the resolving power of different angles in MPR images of 16DAS-MDCT].

In this study, we evaluated the resolving power of three-dimensional (3D) multiplanar reformation (MPR) images with various angles by using 16 data acquisition system multi detector row computed tomography (16DAS-MDCT) . We reconstructed the MPR images using data with a 0.75 mm slice thickness of the axial image in this examination. To evaluate resolving power, we used an original new phantom (RC phantom) that can be positioned at any slice angle in MPR images. We measured the modulation transfer function (MTF) by using the methods of measuring pre-sampling MTF, and used Fourier transform of image data of the square wave chart. The scan condition and image reconstruction condition that were adopted in this study correspond to the condition that we use for three-dimensional computed tomographic angiography (3D-CTA) examination of the head in our hospital. The MTF of MPR images showed minimum values at slice angles in parallel with the axial slice, and showed maximum values at the sagittal slice and coronal slice angles that are parallel to the Z-axis. With an oblique MPR image, MTF did not change with angle changes in the oblique sagittal slice plane, but in the oblique coronal slice plane, MTF increased as the tilt angle increased from the axial plane to the Z plane. As a result, we could evaluate the resolving power of a head 3D image by measuring the MTF of the axial image and sagittal image or the coronal image.

Evaluation of blending effect of composites related to restoration size.

OBJECTIVE: It has been clinically observed that color differences between teeth and some restorations are smaller than if they are viewed in isolation. The objective was to evaluate in vitro the influence of restoration size, initial color difference and translucency on blending effect (BE) of resin composites. METHODS: Specimens were made of two composites (2CS, n = 5). The outer ring (D=10 mm, 2-mm thick) was made of Palfique Estelite (PE, C2 shade), while the inner composites (D = 2-, 4-, and 6-mm, 2-mm thick) were PE and Esthet-X (EX, A2 and B2 shades of both materials). Single-composite specimens (1CS) of all five shades (D = 10 mm, 2-mm thick, n = 5, batch) were made as well. Visual color assessments were done by six observers using a 1-5 scale. The BE were calculated as a difference in visual scores between corresponding 2CS and 1CS. 1CS were additionally evaluated using a spectrophotometer (D55, 10 degrees). Intra-and inter-observer agreements were tested. RESULTS: The blending effect for comparisons of PE/A2 for 2-, 4- and 6-mm inner composite was 2.7, 1.7, and 1.7, respectively. Lower values were recorded for PE/B2 (1.7, 1.2, and 1.1), EX/A2 (0.3), 0.0, and 0.1) and EX/B2 (-0.2, -0.1, and -0.1). The correlation coefficient (r) among BE for 2-, 4-, and 6-mm inner composite (2CS) and deltaE* among batch shades and PE/C2 (1CS) were 0.98, 0.95, and 0.97, respectively. SIGNIFICANCE: Discovering and quantifying mechanisms of color shift of dental materials towards color of surrounding teeth may improve the esthetics of restorations and simplify shade matching.

Color interaction of dental materials: blending effect of layered composites.

OBJECTIVES: To evaluate the in vitro blending effect (BE) of layered resin composites related to material, shade, and differences in color and translucency between compared materials. METHODS: Specimens made of two composites (2CS, n=5) consisted of the outer composite with an outer diameter of 10mm, 4mm thick and an inner diameter of 4mm, 2mm thick for the inner composite. Thus, the inner composite was encircled by a 3mm outer composite around its circumference and backed by a 2mm thick outer composite, to simulate a dental restoration surrounded by hard dental tissues. The outer composite was Palfique Estelite (PE, C2 shade, standard shade), while the inner composites were PE A2, B2 and C2 shades and corresponding shades of Point 4 (P4), Tetric Ceram (TC) and Filtek A110 (FA) composites (batch shades). Single-composite, disk-shaped specimens (1CS) of all five shades (D=10mm, 2mm thick, n=5) were made as well. Visual color assessments were done by six observers using a lightbooth and 1 (mismatch) to 5 (perfect match) scale. The BE was calculated as a difference in scores between corresponding 2CS and 1CS. Z-scores and corresponding BE values (BE(Z)) were calculated. 1CS were also evaluated using a spectrophotometer. RESULTS: Blending effect ranged from -0.4 to 2.2, while BE(Z) ranged from -0.6 to 3.0. Mean visual scores for 1CS and 2CS were 1.8 (1.2) and 2.2 (1.3), respectively. BE increased with a decrease in color difference (r=0.41) and increase of translucency parameter (TP, r=0.77). High agreement was recorded among pairs of observers for both 1CS, r=0.95 (0.03) and 2CS, r=0.96 (0.02). SIGNIFICANCE: Blending effect is composite and shade dependent. Quantifying of blending potential of dental materials might provide useful clinical information for dental professionals.

Malaria prevention and stand-by emergency treatment among Japanese travelers.

BACKGROUND: While chemoprophylaxis remains the safest option for most travelers to malaria high-risk areas, stand-by emergency treatment (SBET) may also be a sensible option especially for travelers to low-risk areas, due to the possible adverse effects (AEs) of prophylactic antimalarials. However, studies on the suitability of SBET actually implemented by travelers are scarce, especially those targeting Japanese travelers. We investigated to what extent malaria prevention measures are taken and how effectively SBET is used by Japanese travelers to malaria-endemic areas. MATERIALS AND METHODS: A questionnaire study was conducted targeting Japanese travelers who visited quarantine stations for pre-travel health advice and who had previously visited malaria-endemic areas as defined by the World Health Organization (N = 160). RESULTS: The results showed that only a minority (13%) of travelers to malaria-endemic areas took chemoprophylaxis. Although most (89%) of the SBET users (N = 9) took antimalarial drugs when they experienced both fever and chills, characteristic of clinical malaria, there were several problems related to SBET. Some (22%) of the subjects conducted SBET less than 7 days after entering the area, most (89%) of them did so when a medical facility was readily accessible, and many (56%) failed to seek medical attention soon after SBET or did not at all. CONCLUSIONS: Japanese travelers to malaria-endemic areas seemed less protected with the use of chemoprophylaxis. Furthermore, problems related to SBET among Japanese travelers were identified. These should be taken into full consideration when educating both travelers and travel health professionals to avoid risks of malaria and possible AEs of antimalarial drugs.

Color compatibility of resin composites of identical shade designation.

OBJECTIVE: The aim of this study was to evaluate color compatibility of corresponding resin composite shades keyed to Vitapan Classical shade guide (Vita). METHOD AND MATERIALS: Twenty-one shades of 6 commercial resin composites were analyzed. Specimens (n = 5) were made as disks, 11 mm in diameter and 2 mm thick, using cylindrical molds. Specimens were polymerized according to manufacturers' suggestions using a light-curing unit. Data were collected using a spectrophotometer and analyzed using the appropriate color difference metric equations. A total color difference (deltaE*ab) greater than or equal to 3.7 was considered a mismatch. Analysis of variance and Fisher's probable least-squares difference (PLSD) test. intervals for comparison of means were calculated at the .05 level of significance. RESULTS: Mean deltaE*ab values among A2, B2, C2, and opaque A2 shade pairs were 4.4 (1.8), 7.3 (3.2), 5.6 (2.8), and 6.5 (1.8), respectively, while the mean color difference for all the pairs compared was 5.8 (2.8). For A2 shades, deltaL*, deltaa*ab, and deltab*ab values ranged by 5.3, 2.3, and 6.7, respectively. Corresponding values for B2 shades ranged by 10.5, 2.2, and 11.5; 7.9, 2.2, and 4.3 for C2 shades; and 7.9, 1.4, and 4.4 for opaque A2 shades. Fisher's PLSD critical intervals for comparing deltaE*ab values among the shades and composite pairs were 0.07 and 0.15, respectively (P < .0001, power 1.00). CONCLUSION: Overall, poor color compatibility of shade pairs of identical shade designation was recorded. The best color match was recorded for A2 shade pairs, followed by C2, B2, and opaque A2 shade pairs.

Laboratory-confirmed Mediterranean spotted fever in a Japanese traveler to Kenya.

A Japanese traveler returning from Kenya became ill, presenting with fever and a prominent, generalized rash without an eschar. Results of the immunofluorescence antibody assay of the patient's sera performed in Japan were compatible with illness due to a spotted fever group (SFG) rickettsia, and a presumptive diagnosis of African SFG rickettsiosis, probably either Mediterranean spotted fever (MSF) or African tick-bite fever (ATBF), was rendered. To further define the disease diagnosis, sera were examined in France by Western immunoblotting combined with cross-adsorption, which confirmed the diagnosis of MSF but not of ATBF. Because of the need to further characterize the epidemiologic and clinical features of the two African SFG rickettsioses, clinicians are encouraged to contact a specialized laboratory when encountering such cases.

Clinical characteristics of imported malaria in Japan: analysis at a referral hospital.

Imported malaria remains an important problem in Japan. We have reviewed the medical records of 170 cases of malaria in our hospital, which corresponds to 14.9% of the total cases in Japan. The predominant malarial species was Plasmodium falciparum (52.3%), and the most frequent area of acquisition was Africa (54.2%), followed by Asia (20.9%) and Oceania (19.6%). The most common reason for travel among Japanese patients was business. A significant proportion (22.2%) of vivax malaria cases experienced relapse despite standard primaquine therapy. Most primaquine failures were from Oceania. We also found that a substantial number of Japanese patients contracted malaria without chemoprophylaxis and consulted medical facilities with an unfavorably long delay from initial symptoms (median: 3.0 days). Direct education of travelers and travel companies, in addition to health care providers, is likely necessary to improve outcomes of imported malaria.

Diagnosis of febrile illnesses in returned travelers using the PC software GIDEON.

BACKGROUND: The prompt and accurate diagnosis of febrile illnesses should have the highest priority when dealing with returned travelers. However, traditional diagnostic procedures aided by collecting information from printed materials may have drawbacks. Here, we conducted a retrospective study to evaluate the diagnostic capability of the software, Global Infectious Disease and Epidemiology Network (GIDEON). METHOD: We recruited a total of 98 febrile travelers in whom an infectious disease diagnosis had been confirmed by microbiology and/or serology. The presence or absence of symptoms/signs and laboratory abnormalities, travel destination, entry and departure dates, and the date of onset were input into updated versions of GIDEON. RESULTS: Overall, the correct diagnoses appeared on the differential diagnosis lists for 91% of the cases and ranked first for 52%. A correct diagnosis could be excluded from the differential diagnostic list by the presence of symptoms and signs irrelevant to the disease, which was demonstrated most clearly in a case of Lassa fever. We also found that a correct diagnosis can be listed lower than expected, probably due to the irrelevant database. CONCLUSIONS: Improvements are required at the level of the developer and users are required to have adequate knowledge of infectious diseases for best use of the program. Despite these limitations, we believe that GIDEON is a novel and potentially powerful tool in infectious disease diagnosis.

Optimal primaquine use for radical cure of Plasmodium vivax and Plasmodium ovale malaria in Japanese travelers--A retrospective analysis.

BACKGROUND: Recently, a dose of 30 mg (base) primaquine daily for 14 days is increasingly recommended for radical cure of Plasmodium vivax malaria. However, total primaquine doses, or those per body weight, are also recognized as important. In Japan, primaquine is not a licensed medicine, but has been used through the Research Group on Chemotherapy of Tropical Diseases for >3 decades. METHODS: Based on clinical records submitted to the Research Group, patients with P. vivax and Plasmodium ovale malaria treated with primaquine were analyzed to determine the efficacy and safety of the antimalarial drug. RESULTS: Seventy-five P. vivax cases, including 3 in children, and 19 P. ovale cases were enrolled. Five of the P. vivax cases demonstrated at least one relapse despite primaquine therapy. Total primaquine doses per body weight were obtained in 4 of the 5 relapsed patients, presenting 9 malaria episodes totally, and most of the primaquine failures were caused with a total dose ≤ 3.5 mg/kg. Liver function disturbance was reported in 2 cases. CONCLUSION: In order to optimize radical cure of P. vivax, the total primaquine dose per body weight should be considered, at least 3.5 mg/kg or even more if contracted in countries with significant drug resistance. Possibility of primaquine hepatotoxicity in chronic liver disease patients remains to be elucidated.

Imported malaria in pregnant women: A retrospective pooled analysis.

BACKGROUND: Data on imported malaria in pregnant women are scarce. METHOD: A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done using data from 1991 to 2014 from 8 different collaborators in Europe, the United States and Japan. National malaria reference centres as well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 631 cases were collated, providing information on Plasmodium species, region of acquisition, nationality, country of residence, reason for travel, age, gestational age, prophylactic measures and treatment used, as well as on complications and outcomes in mother and child. RESULTS: Datasets from some sources were incomplete. The predominant Plasmodium species was P. falciparum (78.5% of cases). Among the 542 cases where information on the use of chemoprophylaxis was known, 464 (85.6%) did not use chemoprophylaxis. The main reason for travelling was "visiting friends and relatives" VFR (57.8%) and overall, most cases of malaria were imported from West Africa (57.4%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome were limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported. CONCLUSIONS: Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa. Malaria prevention and treatment in pregnant travellers is a challenge for travel medicine due to few data on medication safety and maternal and foetal outcomes. International, collaborative efforts are needed to capture standardized data on imported malaria cases in pregnant women.