西非五国对疟疾的知识、传统措施和蚊帐防蚊的比较研究

本研究的主要现场工作是在冈比亚进行,并在加纳、几内亚比绍、塞拉利昂和塞内加尔进行了短期调查以进行蚊帐使用等的比较。所有调查点均由经过训练的当地现场工作者采用设计周密的调查表进行,并由重点访谈对象提供更多的信息。 对疟疾成因的认识:加纳、几内亚比绍和塞拉利昂近半数回答蚊是疟疾的原因,在塞内加尔和冈比亚,只有1/4回答正确。在冈比     

用乙胺嘧啶/氨苯砜对儿童疟疾作化学预防后出现的皮肤色素沉着斑

使用杀虫剂浸泡蚊帐和服用化学抑制剂被认为是预防儿童及孕妇疟疾的最有效的方法。常用的化学抑制剂是Maloprim(乙胺嘧啶/氨苯砜)。为验证两者效果,在塞拉利昂进行了一次试验。年龄为3—59个月的儿童使用乙胺嘧啶/氨苯砜预防疟疾后出现了意料未及的副反应。     

中国消除疟疾流行后如何加强临床医生疟疾的诊治能力

作为无疟疾认证的国家,输入性疟疾的防治现已成为我国保持消除疟疾状态的重要任务,而提高临床医生对疟疾的诊治能力,降低疟疾的病死率是其中重要一环.本文从延迟诊断、检验能力、延迟给药、抗疟疾药物使用不规范及重症疟疾综合抢救能力不足这5个导致重症疟疾病死率难以降低的原因逐一阐述,以期提高疟疾诊治水平和重症疟疾救治成功率.     

南通市重症疟疾病例特征及诊治情况分析

目的 回顾性分析南通市重症疟疾病例特征和诊治情况,总结重症疟疾的成因、评价诊治效果,为制定切实可行的重症疟疾救治措施提供科学依据。方法 收集2009-2016年南通市所有疟疾病例资料,对重症疟疾病例的发病时间、临床表现、诊断过程、治疗情况进行汇总分析。结果 2009-2016年南通市共报告疟疾病例359例,其中重症病例26例,均为境外输入性恶性疟病例,其中脑型疟12例、急性肾功能衰竭11例、重度贫血3例。26例重症疟疾病例从发病至就诊的平均时间为3.1 d,平均时间最长者在发病第12天才就诊;从发病至确诊的平均时间为5.2 d,其中11例在发病5 d后得到确诊。乡（镇）医院首诊确诊率为25.00%（1/4）,县级医疗机构首诊确诊率为90.91%（10/11）。26例重症疟疾病例通过抗疟治疗和临床对症治疗均治愈,无死亡病例。结论 重症疟疾临床表现复杂、并发症多、危害严重,加大对赴疟疾高度流行区人员的疟疾宣教、提高诊治单位医务人员对疟疾的诊治能力和镜检技能,可有效减少重症恶性疟病例发生、避免疟疾病例死亡。     

以皮疹、腹泻为首发症状的脑型疟1例

非洲地区是疟疾的高流行地区,其中恶性疟的发病率和病死率最高.本文通过报道我国援坦桑尼亚医疗队诊治的1例以皮疹和腹泻为首发症状的脑型恶性疟患者的体会,以期为临床医生在诊治疟疾时提供参考、借鉴.     

坦桑尼亚区级医院疟疾治疗的调查分析

在坦桑尼亚西北农村的Murgwanza医院,疟疾在门诊和住院病人中最常见,也是导致死亡的第一位病因。面对不断增加的疟疾病例及氯喹抗性等问题,作者对该医院疟疾的诊治状况进行了调查。调查包括1990年4月15日至1991年4月14日诊断为疟疾且     

新型冠状病毒肺炎防控期间规范疟疾诊疗流程的建议

2019年底新型冠状病毒肺炎的暴发流行,给疟疾等其他疾病的诊治工作带来了新的挑战。如果疟疾(尤其恶性疟)患者被漏诊误诊,有可能引发重症甚至危及生命。而如果防护和处置不当,不仅疟疾患者在就诊的过程中有可能感染新型冠状病毒,医务人员同样也面临很大的风险。因此,本文围绕当前疫情形势下如何做好疟疾诊治工作,对规范开展疟疾患者的诊疗流程提出建议,供医务工作者参考。     

2000～2007年绍兴县疟疾监测情况分析

2000～2007年绍兴县共发现疟疾病人30例,全部为输入性病例,提示绍兴县应加强流动人口管理和监测,及早诊治疟疾病人,防止疟疾在当地的传播和和流行.     

在乌干达务工及回国人员疟疾病例报告

目前我国非疟区医务人员,偶尔诊治疟疾病例有时容易误诊或漏诊而延误治疗,甚至危及患者生命。作者于2005-2007年参加援助乌干达医疗队,现将诊治和收集的5例华人疟疾病例进行回顾性分析,报告如下。     

镇江市丹徒区消除疟疾达标考核评估分析

目的 对镇江市丹徒区消除疟疾达标考核评估结果进行分析,为巩固消除疟疾防治成果提供依 据。 方法 查阅 ２０１０ ～ ２０１６ 年区级消除疟疾相关资料,核实国家疾病监测信息报告管理网报和寄生虫病信 息专报系统疟疾疫情资料;现场血片复检并考核临床医生疟疾诊治知识和检验人员疟原虫镜检技能。 结果 镇江市丹徒区 ２０１０ ～ ２０１６ 年网报和专报疟疾实验室确诊病例 ３ 例,均为境外感染的输入病例,７ 年间未发 生本地疟疾病例;共血检发热病人 ２４ ２１９ 人次,血检率为 １． ２３％ ,血检阳性 ３ 人,阳性率为 ０． ０１％ ;血片复 检 ３ ９２１ 张,复检率为 １６． ２０％ 。 现场考核,血片复核得分 ９． ７５ 分（１０ 分制）,疟疾诊治知识和镜检技能考核 合格率 １００％ ,消除疟疾考核总得分为 ９９ ４５ 分。 结论 镇江市丹徒区通过消除疟疾达标考核,在今后巩固 消除疟疾的防治成果工作中需继续抓好血检质量、主动病例侦查和输入性疟疾的防治等工作。     

Syndromic Diagnosis of Malaria in Rural Sierra Leone and Proposed Additions to the National Integrated Management of Childhood Illness Guidelines for Fever

Many countries in Africa, including Sierra Leone, have adopted artemisinin-based combination therapy as first-line therapy for treatment of patients with malaria. Because laboratory testing is often unavailable in rural areas, the cost-benefit and viability of this approach may depend on accurately diagnosing malaria by using clinical criteria. We assessed the accuracy of syndromic diagnosis for malaria in three peripheral health units in rural Sierra Leone and determined factors that were associated with an accurate malaria diagnosis. Of 175 children diagnosed with malaria on syndromic grounds, 143 (82%) were confirmed by the Paracheck-Pf test. In a multivariate analysis, splenomegaly (P = 0.04) was the only clinical sign significantly associated with laboratory-confirmed malaria, and sleeping under a bed net was protective (P = 0.05). Our findings show that clinical malaria is diagnosed relatively accurately in rural Sierra Leone. Incorporating bed net use and splenomegaly into the national Integrated Management of Childhood Illness guidelines for evaluation of fever may further enhance diagnostic accuracy for malaria.     

It all began with Ronald Ross: 100 years of malaria research and control in Sierra Leone (1899-1999)

It was in Sierra Leone, 100 years ago in 1899, that human malarial parasites were first observed in wild-caught Anopheles gambiae and An. funestus, the principal vectors of malaria in Africa. In the same year, Ronald Ross initiated the first antilarval measures for malaria control. This paper reviews 100 years of malaria field research and control in Sierra Leone, which became known as the 'White Man's Grave' in the 19th century largely because of the high malaria-related mortality amongst Europeans living there. The establishment of a field laboratory for the Liverpool School of Tropical Medicine in Freetown in 1920 made Sierra Leone the centre for malaria field research in Africa up to and during the Second World War. Eminent malariologists including Ronald Ross, Samuel Christophers, George Macdonald, Leonard Bruce-Chwatt, Brian Maegraith, Ian Macgregor, Brian Greenwood and Michael Service visited Sierra Leone for malaria-related activities. This review highlights the tremendous efforts made towards defining the epidemiological picture of the disease and the most effective means of combatting it. Malaria control in Sierra Leone, as in many other parts of the world, used to be based largely on mosquito eradication. However, experience gained over the past 100 years has shown that mosquito control is often not cost-effective in areas where the interruption of transmission cannot be sustained. Emphasis should now be on early diagnosis, treatment with effective antimalarials, and the selective use of preventive measures including vector control and insecticide-treated materials where they can be sustained.     

Apparent drug failure following artesunate treatment of Plasmodium falciparum malaria in Freetown, Sierra Leone: four case reports

Four cases of Plasmodium falciparum malaria who presented in Sierra Leone in November-December 2000 apparently failed to respond to treatment with artesunate. Three (75%) of the cases fulfilled the World Health Organization's criteria for late treatment failure. Although artesunate ranks only sixth as the first-line drug used by clinicians for the treatment of uncomplicated malaria in Sierra Leone, it is widely sold over the counter in pharmacies in the country. The indiscriminate and injudicious use of artesunate among the Sierra Leonean population is likely to increase the level and frequency of resistance among the local strains of P. falciparum. It is recommended that artesunate be reserved for patients who fail to respond to treatment with another of the antimalarial drugs available. Even then, the artesunate should preferably be used in combination with other, longer-acting antimalarial drugs, to slow the development of further resistance.     

Prevalence and distribution of spotted fever and typhus infections in Sierra Leone and Ivory Coast

A serosurvey for evidence of rickettsial infections was conducted in the rural populations of several tropical rain forest areas in Sierra Leone and Ivory Coast. Seropositivity rates were surprisingly high in both countries, with more than 7% of the individuals in some districts having antibodies to spotted fever-group rickettsiae. No significant difference was found in the overall prevalence of diagnostic antibody titers to spotted fever-group rickettsiae in Sierra Leone (5.3%) and Ivory Coast (6.2%). However, there was a significant difference (p less than 0.001) in the prevalence of diagnostic antibody titers to typhus rickettsiae in the two countries. There were no marked geographic differences within either country in overall prevalence of rickettsial infections, but there were possible area differences in specific seropositivity rates to typhus- and spotted fever-group rickettsiae in Sierra Leone. In both countries, age and sex differences were important in determining seropositivity, but there was no indication of an age-sex interaction. In Sierra Leone, 59 of the 80 positive sera (73.8%) were from persons age 15 or above (p less than 0.001), and 50 of the 80 (62.5%) were from males (p = 0.05). In Ivory Coast, 33 of the 37 positive sera (89.2%) were from the greater than or equal to 15-age group, and 28 of the 37 (75.7%) were from males (p less than 0.001 for both age and sex). The identification of specific areas endemic for these rickettsial diseases should facilitate the diagnosis and treatment of patients with rickettsial illnesses in West Africa.     

Low efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone

OBJECTIVE: In 2004, Sierra Leone adopted artesunate plus amodiaquine as first-line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. METHODS: Method and outcome classification of the study complied with WHO guidelines. Children 6-59 months with uncomplicated malaria were followed-up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. RESULTS: Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8-99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR-adjusted day 28 efficacy was 84.5% (95% CI: 76.4-90.7). All true failures occurred in the last 8 days of follow-up. Of 110 children who completed the 28-day follow-up, 54 (49.1%) experienced a novel infection. CONCLUSION: The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone.     

塞拉利昂弗里敦地区老年埃博拉病毒病患者临床特点研究

目的研究塞拉利昂弗里敦地区老年埃博拉病毒病(Ebola virus disease,EVD)患者的临床特点。方法选取我国解放军援塞医疗队2014年10月—2015年3月收治的老年(60岁)EVD确诊患者21例(老年组)进行回顾性分析,研究其临床特点。选取同期收治的非老年EVD患者235例(非老年组)作为对照。结果老年组病毒载量与非老年组差异无统计学意义。老年组主要临床表现依次为发热、乏力、纳差、腹痛、头痛、咳嗽、关节痛、恶心呕吐、腹泻、肌肉痛、胸痛和结膜炎。老年组腹痛(85.7%)和精神错乱(23.8%)的发生率均高于非老年组[64.3%(P=0.047)和8.9%(P=0.047)],关节痛(61.9%)的发生率低于非老年组(83.0%)(P=0.018)。老年组病死率(33.3%)与非老年组(39.1%)差异无统计学意义,老年组入院后至死亡的平均死亡时间[(3.0±1.4)d]与非老年组[(2.3±1.7)d]差异亦无统计学意义。结论老年EVD患者临床表现及预后与非老年EVD患者类似,但仍具有其自身特点,这对诊断和治疗具有重要的指导意义。     

Anthelminthic treatment and haemoglobin concentrations during pregnancy

A longitudinal study was conducted in Sierra Leone to measure the impact of a single dose anthelminthic (400 mg albendazole) and daily iron-folate supplements (36 g iron and 5 mg folate) on haemoglobin (HG) concentration during pregnancy. After controlling for baseline Hb concentration and season, anthelmintic treatment reduced the decline in haemoglobin concentration between the first and third trimesters by 6.6 g/L (p=0.0034) relative to the control. The corresponding value for iron-folate supplements was 13.7 g/L(p<0.0001) [corrected]. These findings indicate that anthelminthic treatment should be included in strategies to control maternal anaemia in Sierra Leone.     

The United States to Africa lupus prevalence gradient revisited

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that has a significantly higher prevalence, morbidity and mortality in African Americans compared with Americans of European descent. The pathogenesis of lupus is unclear but appears to be a result of environmental factors interacting with a genetically susceptible host. Despite the high disease load of SLE in African Americans, there is the perception that lupus is relatively rare in Africa. This prevalence gradient suggests that comparative studies of related cohorts from the two continents may provide insight into the genetic/environmental interactions that result in the development of lupus. To define if a lupus gradient exists, we began a study of autoimmunity prevalence utilizing two unique cohorts. The first is the Gullah population of the Sea Islands of South Carolina, who are unique in their low genetic admixture and their known ancestral heritage. The second is the population of young women served by the West Africa Fistula Foundation in Bo, Sierra Leone. Anthropologic studies indicate a direct ancestral link between the Gullah population and Sierra Leoneans. Since it is impossible to perform an epidemiologic study of lupus in Sierra Leone at this time, we assessed the prevalence of lupus serum autoantibodies, serologic evidence of specific infections and levels of serum 25-OH vitamin D in young women in the two cohorts who have no known relatives with lupus. Our results indicate similar prevalence of serum antinuclear antibodies in the two cohorts, though there was a significantly increased prevalence of antiphospholipid and anti-Sm antibodies in the Sierra Leone cohort. Seropositivity to common viral infections was significantly higher in women from Sierra Leone, while serum 25-OH vitamin D levels were markedly lower in the Gullah population. These data suggest that the prevalence of autoimmunity is similar in the two populations, but that there are significant environmental differences that may impact progression to autoimmune disease. Further studies comparing these two cohorts is likely to provide important insight into the impact of environmental factors on development of lupus.     

The role of traditional treatment on health care seeking by caregivers for sick children in Sierra Leone: Results of a baseline survey

In Sierra Leone, traditional treatment is at times used in lieu of seeking allopathic healthcare for major illnesses causing child death. This paper describes the nature of traditional treatment for diarrhea and fever (presumed malaria). Weighted analysis and multi-logistic regression was applied to a household cluster survey (n = 5951) conducted in 4 districts in June 2010. Using structured questionnaires, heads of households, and caregivers of children under five years of age were interviewed about child morbidity and care seeking. A thematic analysis of qualitative data based on focus group discussions and in-depth interviews with family members from twelve villages in these same four districts, was also done. Illness-specific herbal remedies were described by respondents. Among 1511 children with diarrhea, 31% used traditional treatment. Among 3851 children with fever, 22% used traditional treatment. Traditional treatment for diarrhea was associated with being from a tribe other than the Mende, using government recommended salt sugar solution, not having a vaccine card, having more than two illnesses, and not seeking any allopathic medical treatment for diarrhea. For fever, traditional treatment was associated with being a tribe other than the Mende, having more than two illnesses, not having a vaccine card, Muslim religion, and not seeking any allopathic medical treatment for fever. Qualitatively, respondents describe herbalists as trusted with remedies that are seen to be appropriate due to the perceived cause of illness and due to barriers to seeking care from government providers.The social determinants of traditional treatment use and the prominent role of herbalists in providing them need to be addressed to improve child survival in Sierra Leone.     

Failure of falciparum malaria prophylaxis by mefloquine in travelers from West Africa

Due to the spread of chloroquine-resistant strains of Plasmodium falciparum in French speaking parts of Africa, we have found it necessary to prescribe mefloquine for antimalaria prophylaxis to travelers to this area. Weekly doses of 125 or 250 mg have been recommended for short journeys. In spite of this regimen, 16 documented cases of falciparum malaria in travelers have been recorded in the Bordeaux hospital center since October, 1988. Fifteen of these patients were tourists returning from West African countries, and one was an Ivorian student who had been on vacation to his home country. Nine of these patients were evaluated and found to have high plasma mefloquine levels. This report strongly supports the existence of mefloquine-resistant falciparum malaria in West Africa, especially in Sierra Leone, Burkina Faso, and Cote d'Ivoire.