5 It is worth noting that in the four more recent and authoritative

guidelines for the treatment of malaria, mefloquine was excluded for the treatment of acute uncomplicated malaria in two cases (ie, WHO and UK guidelines)11,13 and in the others the drug was ranked as second (French guidelines)12 or fourth line treatment (CDC).10 In the light of a widespread availability of artemisinin compounds also in Europe it is plausible that mefloquine will be progressively abandoned to avoid the infrequent, but sometimes severe psychiatric side effects. As far as the rate of severe P falciparum malaria is concerned in our case file it was 5-Fluoracil ic50 slightly higher (15%) in comparison with the pooled frequency obtained from series of imported malaria considered here (102/1,465, 6.9%),3–5,16,21,23,24 but the outcome was favorable

with no death from malaria. Although the retrospective nature of our study is subject to several biases we can speculate that the rapid and high level collaboration with our intensivists might have played an important role in achieving this result. It is worth noting that the average case fatality rate registered in Italy between the years 2000 and 2006 was 0.5%; that is substantially similar to the 0.4% observed in France in a study performed over 8 years regarding about 22,000 patients with P falciparum malaria27,28 Navitoclax and better than those reported in other European countries.29 In the management of severe P falciparum malaria the universally recognized issue is the immediate start of the appropriate parenteral treatment. The Ribonucleotide reductase recently published results of AQUAMAT study definitively demonstrated, together with those obtained in the SEQUAMAT, that in the treatment of severe falciparum malaria, intravenous

artesunate (not available in Europe and investigational in United States) is superior to quinine when both are given intravenously.30 In conclusion, our study and the analysis of the literature concerning treatment of imported malaria show that incorrect prescription of anti-malarial therapy occurs also in highly specialized infectious diseases wards. Retrospective surveys of case files are helpful to identify inappropriate management and to introduce corrective measures to ensure high standards of care. The authors state that they have no conflict of interests. “
“A dramatic increase of reported bedbug (Cimex lectularius and Cimex hemipterus) infestations has been observed worldwide over the past decade. Bedbug infestations have also been detected across a wide range of travel accommodations, regardless of their comfort and hygiene levels. Travelers are increasingly exposed to the risks of bedbug bites, infestation of personal belongings, and subsequent contamination of newly visited accommodations and their homes. We searched Medline publications via the PubMed database.