2008年山东省疟疾流行病学特征分析

2008年山东省报告疟疾病人174例,其中男143例,女31例;间日疟102例,恶性疟37例,未分型35例;新发病例119例,复发55例;当地感染72例,外地感染102例。加强各级业务人员的疟防技能培训以及流动人口疟疾管理将是山东疟防工作的重点。     

2006～2010年37例住院疟疾病例分析

对2006~2010年6月本院诊治的疟疾病历资料进行回顾性分析。结果 37例疟疾病人中,10例为间日疟,27例为恶性疟;31例为境外输入性病例,6例为国内当地感染病例。病人均有明确的疟区生活史,大部分病人热型不规则,临床症状不典型。恶性疟病人均首选青蒿素类药物正规治疗,间日疟病人首选氯喹及伯氨喹八日疗法,同时给予抗炎保肝等对症处理。37例疟病病人均治愈出院,无死亡病例出现。     

2005～2011年杭州市萧山区疟疾疫情分析

2005～2011年5月杭州市萧山区共报告疟疾病例50例,其中间日疟34例,恶性疟4例,未分型12例;男性35例,女性15例;患者年龄在2～48岁;职业以农民、民工和儿童为主;本地病例39例,输入性病例11例;病例分布于19个街道和镇;病例多集中于每年的6～10月份。杭州市萧山区疟疾感染水平低,多为散发。     

上海市88例本地感染疟疾流行病学特征分析

目的 了解和掌握上海市疟疾流行规律与特征.方法 对2003～2007年上海市本地感染疟疾病例的流行病学特征进行分析.结果 在5年间共发现了88例本地感染病例,占疟疾报告病例的13.12%(11.17%～15.12%);其中间日疟72例,没有恶性疟病例,16例未分虫种;病例分布于10个郊区县,为散发;发病季节主要集中于8～10月份;男女性别比为2.38:1,年龄在3～79岁间,其中本地居民的年龄主要集中于30～60岁,外来人员的年龄主要为20～40岁;职业以农民、民工和工人为主.结论 本市本地感染疟疾为低水平、散发;多为间日疟,无恶性疟;主要分布于外来人员集中的郊区.     

2009-2013年淮安市淮安区疟疾疫情监测

目的 目的 分析近5年来淮安区疟疾疫情监测结果, 为制订相应疟疾防治策略提供依据。 方法 方法 对2009-2013年淮 安区常住人口及外来流动人员中的发热病人进行血检, 并进行蚊媒监测。结果 结果 近5年淮安区共血检常住人口中发热病 人48 203人次, 未检出疟原虫阳性者; 血检流动人口中发热病人360人次, 检出疟原虫阳性病例53例 （间日疟2例、 恶性疟 48例、 未分型3例）, 阳性率为14.72％, 均为到非洲、 东南亚等地区务工感染后的返乡人员。2013年共捕获中华按蚊1 048 只, 未发现其他按蚊。 结论 结论 近5年淮安区无本地感染疟疾病例, 但境外输入性病例较多, 且传疟按蚊和疟疾传播条件依 然存在。     

云南省昌宁县2003～2008年疟疾疫情分析

昌宁县2003~2008年共报告疟疾病例227例,年均发病率1.11/万;本地感染病例37例(占16.30%),外源性病例190例(占83.70%);间日疟153例(占67.40%),恶性疟63例(占27.75%),未分型11例(占4.85%)。全年各月均有病例出现,季节性不明显;病例以青壮年男性农民和农民工为主;县所辖各乡镇均有疟疾病例,且病例呈高度分散。近年来昌宁县疟疾疫情回升,且出现了以自然村为单位的内源性暴发点,随着输入性病例的增多,疟防形势不容乐观。昌宁县必须重视和加强疟疾防治工作,以防止疟疾暴发流行。     

2005～2010年云南省腾冲县疟疾疫情分析

目的了解腾冲县2005~2010年的疟疾发病情况。方法对各种疟疾资料进行整理,研究疟疾疫情和防控措施。结果腾冲县2005~2010年共报告疟疾病例7 601例,年均发病率为20.03/万,疟疾发病率呈逐年下降趋势。间日疟5 267例,恶性疟1 583例,混合感染82例,三日疟1例,未分型668例;死亡5例。发病以外源性为主,占总发病数的98.24%。结论腾冲县疟疾疫情严重,加强流动人口的管理是控制疟疾疫情的重要措施。     

中缅边境疟疾流行情况调查

回顾性分析2012-2013年云南省盈江县和缅甸克钦邦第二特区拉咱市疟疾疫情资料,并对双边居民开展带虫率调查。2012-2013年盈江县共报告疟疾病例179例,疟疾年均发病率为2.9/万。其中,输入性病例占77.7%(139/179),本地感染病例占22.3%(40/179);间日疟占79.3%(142/179),恶性疟占20.1%(36/179),未分型病例占0.6%(1/179)。缅甸拉咱市共报告疟疾病例2 069例,年均发病率为322.5/万。其中间日疟占73.4%(1 519/2 069),恶性疟占20.1%(415/2 069),未分型病例占6.5%(135/2 069)。血片镜检结果显示,盈江县居民未发现带虫者,拉咱市居民带虫率为1.5%(9/589)。     

2005～2010年济南市疟疾疫情分析

目的了解济南市疟疾发病情况,探讨流行特征,为制定防治对策提供依据。方法对2005～2010年疟疾疫情资料进行整理。对疟疾疫情进行描述与分析。结果济南市2005～2010年共报告疟疾病例66例,其中恶性疟11例,间日疟32例,未分型23例;实验室确诊32例,临床确诊34例;本地病例和外地病例各33例;当地感染病例5例,占7.58%,输入性病例61例,占92.42%,11例恶性疟均为输入性病例。结论济南市疟疾病例以输入性病例为主;关口前移,把好疟疾输入关,加强疟区入济人员的疟疾监测,防止输入病例引起本市疟疾暴发流行应是济南市疟防工作的重点。     

石家庄市2010-2014年输入性疟疾流行病学分析

对石家庄市2010-2014年报告的103例疟疾病例进行流行病学分析。所有病例均为国外输入性病例,其中,间日疟18例(占17.5%)、恶性疟43例(占41.7%)、卵形疟2例(占1.9%)、混合感染18例(占17.5%)、未分型疟疾22例(占21.4%)。发病时间无明显季节性。男女性别比例为33.3∶1。发病年龄集中于20岁~50岁。输入来源主要是非洲(占92.2%)。     

Imported malaria in a Singapore hospital: clinical presentation and outcome.

OBJECTIVE: To evaluate the clinical presentation and outcome of imported malaria. METHODS: A retrospective chart review was conducted of patients with imported malaria admitted to the Communicable Disease Centre (CDC), Singapore (a 130-bed tertiary referral center) from January 1992 to December 1993. An imported case was defined as a smear-positive infection that was acquired in another country. RESULTS: Among 200 malaria patients hospitalized at CDC, 168 imported cases (137 males and 31 females, 131 nonresidents and 37 residents) were studied. The mean age was 31.6 6 10.5 years. The countries visited were India (49.4%), Indonesia (16.7%), and Bangladesh (13%). Five patients had chemoprophylaxis and 36 patients had experienced previous malaria infection. The predominant symptoms were fever (97.6%), chills (79.2%), and rigors (67.9%). Hepatomegaly was detected in 56 (33.3%) and splenomegaly in 49 patients (29.2%). Plasmodium vivax was present in 132 patients, Plasmodium falciparum in 29, and mixed P. vivax and P. falciparum in 7 patients. Parasitemia ranged from 0.1% to 8.0%. Of the vivax cases, 130 were treated with chloroquine, followed by primaquine in 123 patients. Quinine was given to 36 patients (29 falciparum malaria and 7 mixed infections). Median time to fever defervescence was 2 days. Complications occurred in three patients (2 with shock and 1 with pulmonary edema). According to World Health Organization gravity criteria, body temperature over 40 degrees C was detected in six patients, bilirubinemia higher than 50 mmol/L in nine, parasitemia over 5% in five, glycemia less than 2.2 mmol/L in two patients. There were five relapses. No death was recorded. CONCLUSION: Plasmodium vivax is the most common cause of imported malaria, with the majority acquired from the Indian subcontinent. Only a few patients presented with severe malaria.     

Possible role of PGD_2 in malaria infections

Objective:To preliminarily investigate the possible role of prostaglandin D_2(PGD_2) in malaria infections.Methods:Blood and urinary samples(n=120 each) were collected from Thai patients with Plasmodium falciparum(P.falciparum) with moderate(n=26) and high(n=4) parasitemia,patients with Plasmodium vivax(P.vivax)(n=30),patients with fever associated with other infections(n=30),and healthy subjects(n=30).PGD_2 concentrations in plasma and urinary samples of healthy subjects,patients with fever associated with other infections and patients with malaria were determined using Prostaglandin D2-MOX express EIA kit(Cayman Chemical,USA).Results:The possible association between PGD_2 and malaria infections is clearly demonstrated with PGD_2 concentration in urine.The urinary PGD_2 concentrations were relatively high(about 5-fold) in patients with P.falciparum with moderate parasitemia and P.vivax infections compared with other groups.Furthermore,the concentration in patients with P.falciparum with moderate parasitemia and P.vivax infection were significantly higher than that in healthy subjects and patients with fever associated with other infections.Conclusions:Urinary PGD_2 concentrations may offer a more dependable and useful tool for predicting malaria severity.Confirmation is this preliminary finding is required with a larger sample size.     

Malaria control and fever management in Henan Province, China, 1992

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late 'consolidation phase' of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2–3 days and 10% waited longer. One hundred and twenty‐eight patients took self‐medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax . Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.     

Benign tertian malaria--a misnomer?

Plasmodium vivax usually causes an acute self-limiting febrile illness with fever spikes on every third day and no complications or death. Therefore the illness caused by this parasite was termed benign tertian malaria. However, many complications associated with Plasmodium falciparum have been seen with increasing frequency with Plasmodium vivax in recent times. The present study highlights the various complications associated with Plasmodium vivax malaria.     

Clinical evaluation of antimalarial drugs

We have analyzed the clinical data of 189 patients with malaria to establish antimalarial regimens in Japan. The causative parasite species were Plasmodium falciparum in 56 cases (30%), P. vivax in 132 (70%) and P. malariae in 1 (1%). The outcomes f malaria cases are as follows: Cure rats in falciparum and vivax malaria are 86% and 91%, respectively. Two patients died of falciparum malaria and recurrence occurred in 6 cases (11%) of falciparum malaria. Relapse was seen in 12 (9%) of vivax malaria. Chloroquine was most frequently used among antimalarial agents (in 123 cases, 65% of the total) for suppressing acute attacks. The efficacy of chloroquine was evaluated by classifying each case into three groups: chloroquine alone in group one, chloroquine in combination with other antimalarials in group two and other antimalarials except chloroquine in group three. The cure rate among each group is about 80% and there is no difference among them. However, it is noticeable that recurrence occurred when patients were treated with a combination of chloroquine and quinine. We have found a similar result as this in another old report in Japan. Primaquine is effective for eliminating hepatic tissue schizonts but in this study, relapse occurred in 12 cases of vivax, although primaquine had been used in 10 out of 12 cases. In primaquine group, relapse occurred at a similar rate between chloroquine and Fansidar cases. Further studies are needed to decide whether a larger dose of primaquine is appropriate for treatment of vivax malaria. Recovery periods from fever and parasitemia were compared between chloroquine and Fansidar cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Chloroquine for the treatment of uncomplicated malaria in Guyana

At a public hospital in Georgetown, Guyana, 44 patients seeking treatment for symptomatic, slide-confirmed malaria were given standard chloroquine (CQ) therapy and followed for 28 days. The patients apparently had pure infections with Plasmodium falciparum (14), P. vivax (13) or P. malariae (one), or mixed infections either of P. falciparum and P. vivax (17) or of P. falciparum, P. malariae and P. vivax (two). Each received supervised treatment with 10 mg CQ base/kg on each of days 0 and 1, and 5 mg/kg on day 2. On the day of enrollment (day 0), the patients complained of fever (100%), headache (100%), malaise (94%), myalgia (79%), nausea (67%), vertigo (49%) and vomiting (33%). Many (39%) were ill enough to confine themselves to bed. On day 4, fewer of the subjects complained of fever (15%), headache (15%), malaise (6%), myalgia (21%), nausea (6%), vertigo (24%) or vomiting (0%) despite the relatively high (>48%) risk of therapeutic failure. The cumulative incidence of parasitological failure against P. falciparum was 15% at day 4, 33% at day 7 and 48% at day 14. All of the P. vivax and P. malariae infections cleared before day 4 and none recurred by day 7. Two infections with P. vivax recurred later (on day 14 or 28) but in the presence of less than adequate, whole-blood concentrations of CQ plus desethyl-chloroquine (i.e. <100 ng/ml). Taken together, the results indicate a high risk of therapeutic failure of CQ against P. falciparum but also indicate that resistance to CQ in P. vivax occurs infrequently in Guyana.     

Prognostic implication of hypocalcemia and QTc interval in malaria

Hundred confirmed cases of malaria were included in the present study to determine the clinical and prognostic implications of hypocalcemia and corrected QT interval (QTc) prolongation in malaria. Peripheral blood smear examination was done to determine the parasite species and the parasite load. Serum calcium level and QTc measurements in electrocardiogram were done for each patient. Fifty patients were of P. falciparum malaria (38 complicated and 12 uncomplicated), 40 of vivax malaria and 10 patients were having mixed (P. falciparum and P. vivax) infection. Hypocalcemia was found in 26 cases in which QTc was prolonged. Ten patients who had convulsions, all of them were having QTc prolongation and eight had hypocalcemia. A total number of eight patients had muscle spasm, of which six had QTc prolongation and four had hypocalcemia. There were 34 cases of cerebral malaria, of which 18 had hypocalcemia as well as QTc prolongation, 12 of them developed renal failure and 14 had high parasitaemia. Four patients died who had hypocalcemia and QTc prolongation due to hepatorenal syndrome. The mean parasite load, QTc interval and serum calcium were 2.69 +/- 1.0, 0.468 +/- 0.055 sec and 8.16 +/- 0.86 mg/dl respectively in complicated falciparum malaria; 1.6 +/- 0.55, 0.442 +/- 0.043 sec and 8.72 +/- 0.97 mg/dl in complicated mixed (Pf + Pv) infection. 1.33 +/- 0.52, 0.435 +/- 0.035 sec and 9.77 +/- 1.34 mg/dl in uncomplicated falciparum malaria and 1.35 +/- 0.58, 0.403 +/- 0.019 sec and 9.68 +/- 0.99 mg/dl in vivax malaria. The difference was significant between complicated falciparum and mixed (Pf + Pv) infection when compared to uncomplicated falciparum and vivax malaria (p < 0.05).     

Imported malaria at an inner-city hospital in the United States

BACKGROUND: More than 1000 cases of malaria are reported to the Centers for Disease Control and Prevention each year among travelers or immigrants. METHODS: Retrospective study of patients with malaria seen at Grady Memorial Hospital in Atlanta, Georgia, between October 1988 and September 2000. RESULTS: One hundred twenty-six cases of malaria were diagnosed at Grady Memorial Hospital during the study period. Fourteen patients had seen a physician prior to coming to Grady Memorial Hospital, and in 71% the diagnosis was missed. Half had recently immigrated and half recently traveled to an endemic area, yet only 22% of travelers took prophylaxis. Plasmodium falciparum was the most commonly identified species (52.4%), followed by Plasmodium vivax (23.9%). Seventy-two patients (57.1%) required hospitalization. Presenting symptoms included fever (94%), chills (56%), nausea/vomiting (38%), headache (26%), and abdominal pain (26%). Most patients were diagnosed correctly on the day of admission (79%). Twelve patients (16.7%) had severe malaria, and their complications included severe anemia (9.7%), acute renal failure (4.2%), bleeding and/or disseminated intravascular coagulation (4.2%), shock (2.8%), seizures (2.8%), and hypoglycemia (2.8%). One patient died, and two pregnant women had premature deliveries. Median hospital stay was 3.9 days. One third of the hospitalized patients with P vivax failed to receive primaquine, and in 15% of patients with P falciparum, the treatment was considered to be inappropriate. CONCLUSIONS: Although some patients with malaria have a benign course and a good outcome, many patients require hospitalization, and some have severe complications. Increased efforts are needed to educate travelers about the need for prophylaxis.     

Malaria: a 10-year (1994-2003) retrospective study at University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia

Malaria is still one of the most important vector-borne diseases in Malaysia, particularly in remote areas. This retrospective study was carried out to find the prevalence of malaria among patients admitted to UMMC Kuala Lumpur, from 1994-2003. A total of 86 malaria cases were analyzed. Most cases occurred among foreigners [57% (49 cases)] while Malaysians constituted 43% (37 cases). Among foreigners, Indonesians constituted the most [57% (28 cases)]. Among Malaysians, most cases occurred among the Chinese [35% (13 cases)] followed by the Malays [30% (11 cases)]. Males [70%(60 cases)] were more commonly affected. The majority of cases were within the 20-39 year age group (69%). Three species of malaria parasites were reported, of which Plasmodium vivax constituted the most [55%( 47 cases)], followed by Plasmodium falciparum [29% (25 cases)], and only four cases (5%) of Plasmodium malariae. Nine percent (8 cases) were mixed infections. In this study, 12%(10 cases) developed chloroquine resistance: 7 cases of P. falciparum, and 3 cases of P. vivax. The most common complications were jaundice and anemia [77% (23 cases)], followed by blackwater fever [13% (4 cases)] and cerebral malaria [10% (3 cases)]. Most of the complications were due to P. falciparum [43% (13 cases)]. There were no reported deaths. This new source of malaria coming from foreigners must be given serious attention, as it has great potential of increasing malaria cases in urban Malaysia.