gobiernodecanarias.org/istac). According to the last official local register, published by the Instituto Nacional de Estadística, the non-Spanish resident population actually represents 14.3% of the total population

signaling pathway of Canary Islands, and it has increased from 61,523 habitants in 1991 up to 295,464 in 2006 (http://www.ine.es). Sanitary attention demanded by travelers and immigrants in Gran Canaria is becoming more stringent, due to different factors: its strategic geographic situation, the existence of an important maritime transit, and increasing immigration to Europe via the Canary Islands. Unfortunately, there is little information about imported malaria cases in the archipielago.7–9 This is the reason why we consider important to make an update

revision of imported malaria situation in our region. There are three main referral teaching hospitals in the Gran Canaria Island (Hospital Universitario Insular, Hospital Doctor Negrín, and Hospital Materno-Infantil), providing sanitary assistance to a population Afatinib nmr of approximately 700,000 inhabitants. All patients diagnosed with microbiologically confirmed malaria and treated in these hospitals from January 1, 1993 until December 3, 2006 are included in our study. Outpatients with malaria episodes diagnosed and treated in other sanitary centers were not considered. Data on patients diagnosed from 2007 have not yet been made available for detailed investigations. Patients were classified into one of the next four categories: (1) tourist and business travelers returning from malaria Protirelin areas, (2) international sailors stopping over in Las Palmas Port in maritime routes to or from the African continent, (3) immigrants who reside in Gran Canaria and travel to their countries of origin to visit friends and relatives (VFR), and (4) recently

arrived immigrants, meaning immigrants coming from endemic countries who arrived to the island for the first time within the last 6 months. Through clinical records we have retrospectively compiled epidemiological data (age, sex, nationality, travel purpose and destination, and chemoprophylaxis), clinical data (fever, headache, muscle aches, vomits, diarrhea, abdominal pain, colored urine, hepatomegaly, and splenomegaly), indicators of severe malaria (World Health Organization criteria),10,11 complications, treatment, and outcome. We have also registered laboratory findings such as hemoglobin (g/dL), platelet number, leukocyte, alanine aminotransferase (ALT, U/L), aspartate aminotransferase (AST, U/L), and total bilirubin (mg/dL), and microbiology data about Plasmodium species, level of parasitemia, and molecular biology diagnosis [polymerase chain reaction (PCR)]. Diagnosis was based on the parasite demonstration of blood smears through light microscopy. Thick and thin blood films were stained with Giemsa 3% and analyzed for the presence of parasites and parasite species.