OBJECTIVE: To evaluate the presentation and outcome of imported malaria. PATIENTS AND METHODS: Retrospective charts review of hospitalized patients with smear-proven malaria from January 1989 to October 1994. RESULTS: Of a total of 111 cases, 95 were caused by Plasmodium falciparum. Chemoprophylaxis was used in 57% of patients but only 41% were compliant. Parasitemia ranged from 0.1% to 22%. Clinical and biological signs at admission were unspecific. In all cases where both platelets and C-reactive protein were measured, at least one abnormality was noted. More than two WHO gravity criteria were present in 14 cases. Outcome was marked by two deaths and 18 adverse drug reactions. Plasmodium falciparum was associated to only one independent factor in multivariate analysis: symptom onset less than 30 days after return. Chemoprophylaxis use did not modify clinical presentation, mean parasitemia or outcome. CONCLUSIONS: P. falciparum is the most usual cause of imported malaria in France. Normal platelet count and C-reactive protein value probably exclude the diagnosis of malaria in febrile travelers.