疟疾性肝炎

疟疾引起肝脏损害即所谓疟疾性肝炎(以下简称肝疟)临床报道甚少,现将我院12例报告于后,以供参考。一、诊断依据 1.在疟疾流行区(勐腊县属高疟流行区; 2.具有疟疾临床症状和体征; 3.末梢血检出疟原虫无性体; 4.罹患疟疾的过程中出现肝炎临床症状体征如恶心呕吐、纳差、上腹不适、肝区疼痛、肝脏肿大、巩膜或皮肤黄染、肝功能明显损害; 5.经抗疟药与护肝治疗随着疟疾的治愈肝疟也随     

1988-2012年浙江省舟山市定海区疟疾监测分析

目的分析浙江省舟山市定海区1988-2012年疟疾监测结果,为制定有效防治策略提供依据。方法收集整理定海区1988-2012年疟疾监测、发热患者血检等疫情报告数据进行统计分析。结果 1988-2012年全区共检出疟疾46例,年平均发病率为0.05/万,其中2006-2008年疟疾疫情出现小幅上升。本地居民血检25 429人,平均疟原虫阳性率0.04%。流动人口血检1763人,平均疟原虫阳性率3.51%。检出输入性疟疾病例数占全区疟疾病例总数的82.61%(38/46),其中流动人口外地感染的病例数占输入性病例数的71.05%(27/38)。结论舟山市定海区在达到基本消灭疟疾标准后,仍有疟疾病例的输入,加强流动人口管理和监测,防止输入性继发病例的发生,是今后疟疾防控工作的重点。     

2006年浙江省疟疾重点监测县疫情分析

目的 通过对2006年浙江省疟疾重点监测县(市、区)疫情分析,了解新形势下浙江省疟疾流行特征,为制定新的防制策略提供科学依据.方法 对三热病例进行血检,对疟疾病例进行流行病学个案调查,对疟疾媒介进行分类鉴定,对部分人群进行疟疾抗体监测.结果 15个疟疾重点监测县(市、区)共145例疟疾病例,年发病率1.76/10万.本地发热病例血检疟原虫阳性34例,阳性率为0.16%;外来流动人口发热病例血检疟原虫阳性111例,阳性率为2.28%.本地感染者占病例总数14.48%;输入病例占总病例数85.52%,其中,外来人口占输入病例89.52%,本省人口外出感染占输入病例10.48%.结论 浙江省外来流动人口疟疾输入病例呈逐年上升趋势,因此,要制定适应新形势的防疟措施,加强疟疾的监测力度.     

同一血源引起输血性疟疾6例(摘要)

本文对同一血源引起6例输血性疟疾进行了分析,6例中有5例系外科病人,1例系内科病人,发病时均有畏寒、发热、出汗等临床症状,血检发现疟原虫,投抗疟药治疗,症状很快消失,故诊断无疑。供血者来自高疟地区,以献血为职业,O 型     

重症脑型恶性疟疾的护理体会

正疟疾是一种由疟原虫感染引起的急性传染病,传播途径主要由蚊叮咬传播[1]。脑型恶性疟疾的发病非常罕见,本病发病机制是脑内微循环弥漫性内凝血,脑组织出现灶性损害,主要包括缺氧、充血、水肿、炎症及坏死等[2]。其临床表现发热、畏寒、头痛、头晕、嗜睡;严重者可出现昏迷、呼吸衰竭等症状。其治疗效果差,早期给予积极抗疟药物和临床合理治疗,病死率仍高达15%~20%,全世界每年数十万患者死于重症疟疾[3]。该病例是我省首例,在     

苏丹瓦乌12例恶性疟疾病人的护理

疟疾是由疟原虫经按蚊叮咬传播的虫媒传染病,临床上以周期性定时发作的寒战,高热,大汗,并且常伴有剧烈头痛,极度衰弱,全身肌肉酸痛和消化道症状,以及贫血和脾大等特点.疟疾是非洲国家最常见的传染病,其中恶性疟疾是最多见的一种,包括脑型疟,超高型热,急性肾衰竭,肝功能障碍胃肠型,其发病急,来势凶猛,并发症严重,病死率高[1].现将2009年10月-2010年9月在中国驻苏丹瓦乌维和二级医院收治的12例病人的护理介绍如下.     

1例脑型疟疾患儿的治疗及护理

疟疾是全球最严重的虫媒传染病之一,每年约有5亿多人感染,导致100多万人死亡,其中90％病人出现在非洲地区,5岁以下儿童占所有疟疾死亡病例的82％[1].恶性疟疾临床症状复杂多变,进展快,病情重,病死率高.脑型疟疾是由恶性疟原虫引起的急性脑病,是重症疟疾的一种.2011年4月我科收治1例脑型疟疾合并脓毒血症、感染性休克、弥散性血管内凝血的非洲籍患儿,经多方协作,积极治疗,细致护理,患儿很快脱离危险,治愈出院.     

腹膜透析治疗1例儿童重症溶血尿毒综合征的护理

溶血尿毒综合征（HUS）是由多种病因引起的血管内溶血的微血管病,临床上以溶血性贫血、血小板减少和急性肾衰竭为特点。本病好发于婴幼儿和学龄儿童,是小儿急性肾衰竭常见的原因之一。本病分为腹泻后溶血尿毒综合征,亦称典型溶血尿毒综合征和无腹泻溶血尿毒综合征,又称非典型溶血尿毒综合征。我科收治1例重症溶血尿毒综合症患儿,经腹膜透析等综合治疗和精心护理,使患儿转危为安,取得满意效果。现报告如下。1病例简介     

2006年浙江省台州市疟疾疫情分析

目的 掌握2006年台州市疟疾疫情,为深入开展疟疾监测和防控提供依据.方法 收集2006年台州市疟疾疫情报告、监测资料,对结果进行分析.结果 2006年台州市共报告疟疾病例68例,输入病例59例,占86.76%,其中输入恶性疟3例;血检三热患者12 771例,疟原虫阳性59例.结论 疟疾防控形势严峻,应继续开展监测,并以流动人口监测为重点.     

成人恶性脑型疟疾2例临床分析并相关文献复习

目的初步探讨成人恶性脑型疟疾的临床特征、诊断及治疗。方法回顾性分析2例确诊成人恶性脑型疟疾患者的流行病学特征、临床表现、实验室检查、治疗经过及其预后,并复习相关文献。结果 2例成人恶性脑型疟疾患者均有非洲工作或生活史,同时均为急性起病,表现为高热、头昏头痛,意识障碍,同时伴有肝功能异常,累及两系以上血象异常,C-反应蛋白明显升高,外周血涂片均找到恶性疟原虫;予以青蒿琥酯等治疗患者痊愈,其中1例出院后因未服用伯安喹而引起复燃,再次治疗有效。结论成人恶性脑型疟疾在我国多为输入性感染,临床易误诊,有必要反复血涂片找疟原虫以便于确诊;该病起病迅速,病情进展快,及时有效抗疟疾治疗病情恢复快,治疗效果好。     

Therapeutic plasma exchange in the treatment of complicated Plasmodium falciparum malaria: A case report

Severe falciparum malaria is associated with multiple organ dysfunction and a high rate of fatal outcome. Malaria is a world‐wide disease in tropical areas through the bites of vector mosquitoes. Parasitic protozoans introduced by the mosquito's saliva to the blood travel to the liver then mature and reproduce. In humans, malaria is caused by Plasmodium falciparum, P. malariae, P. ovale, P. vivax, and P. knowlesi, and P. falciparum causes most deaths. Typical malaria symptoms include fever, chills, fatigue, headache, nausea, and vomiting. In severe cases, it can cause jaundice, seizures, coma, or death. Jaundice, caused by intravascular hemolysis is a usual complication of malaria, especially in patients with P. falciparum infection. The use of exchange transfusion in malaria is not currently advocated by the Centers of Disease Control and Prevention (CDC) of the United States of America. The role of therapeutic plasma exchange as an adjunctive therapy in malaria has not been widely discussed in the literature. Here, we present a 23‐year‐old patient with jaundice, acute renal failure, and cerebral involvement who was successfully treated with plasma exchange and hemodialysis.     

2017-2020年江西省境外输入性恶性疟原虫的抗药性基因多态性研究

目的 了解2017—2020年江西省境外输入性恶性疟原虫的抗药性情况,为临床用药提供技术支撑。方法 收集2017—2020年江西省输入性恶性疟病例的血液样本,采用巢式PCR方法,对样本抗药性基因进行扩增并测序。结果 共收集到输入性恶性疟病例血液样本85份,均为非洲输入。测序分析得出,恶性疟原虫氯喹抗性转运蛋白基因和多药抗性基因1突变比例较低,为16.67%(14/84)和1.18%(1/85),而二氢叶酸还原酶基因突变比例很高,为96.39%(80/83),未发现Kelch螺旋体蛋白基因的突变。结论 近几年江西省境外输入性恶性疟病例均来自非洲,且恶性疟原虫对氯喹的抗药性较低,可以结合临床实验,考虑用氯喹联合其他药物治疗非洲输入恶性疟病例的可能方案;对乙胺嘧啶抗药性较高,未发现青蒿素抗性株,但因为近2年受新型冠状病毒感染疫情影响,样本量少,不能排除江西省无青蒿素抗性株,需继续监测。     

AUDIT OF IMPORTED AND DOMESTIC MALARIA CASES AT KUALA LUMPUR HOSPITAL

SUMMARY The clinical, haematological and biochemical profiles of all domestic and imported malaria cases admitted to the Hospital Kuala Lumpur were analysed. The most common malaria types were Plasmodium falciparum (39.5%) and Plasmodium vivax (42%). The most common patient type was men aged 29-40 years (reflecting the high mobility of this group, many of whom were illegal immigrants). Misdiagnosis on admission was frequently due to the variable clinical presentation of the disease and the difficulties of obtaining an accurate history. Associated haematological abnormalities were common. Chloroquine resistance was diagnosed in four P. falciparum patients and in one P. falciparum/vivax patient. Overall, imported malaria did not seem more severe than domestic. The three patients with cerebral malaria survived. One patient died of acute liver failure. The large influx of illegal immigrants to Malaysia has resulted in a surge in malaria infection; illegal immigrants remain a source of chloroquine resistance.     

2011-2016年中国境外输入性疟疾流行病学特征研究

目的了解中国输入性疟疾疫情动态趋势,为疫情监测及实现2020年全国消除疟疾目标提供科学依据。方法资料来源于中国疾病预防控制中心信息管理系统2011 — 2016年中国境外输入性疟疾实验室确诊病例,利用ArcGIS、SPSS软件对资料进行描述性分析。结果2011 — 2016年,累计报告输入性疟疾确诊病例18 385例,死亡117例。 死亡病例94.87%由非洲输入,恶性疟占96.58%,死于恶性疟的病例发病到诊断的平均时间（6.92 d）长于存活病例（4.93 d）（F＝15.21, P＜0.001）。 输入病例以男性（94.57%）为主,26～45岁输入病例占全国累计输入病例数的60.92%,输入性病例中农民工占输入病例的70.82%。 输入来源主要为非洲（72.98%）和亚洲（24.87%,以缅甸为主）,非洲输入病例主要集中在加纳（16.70%）、安哥拉（14.44%）、尼日利亚（11.58%）、赤道几内亚（10.79%）,非洲输入病例从2011年的48.71%上升至2016年的84.02%,其中2013年加纳输入1 333例。 我国输入病例以云南省（18.43%）、广西壮族自治区（12.55%）等地区为主。 中国输入性疟疾主要以恶性疟和间日疟为主,间日疟所占比例从2011年的43.81%降至2016年的21.46%,恶性疟、三日疟和卵形疟占比分别从2011年的52.71%、0.67%、0.63%升至2016年的65.25%、2.15%、10.47%。结论当前我国境外输入性疟疾中恶性疟上升比例较快,主要是由于非洲输入病例占比逐年上升。 建议将劳务输出群体作为重点监测人群,提高临床医生能力及时诊断减少死亡病例,防止二代传播。     

An 8-year survey on the occurrence of imported malaria in a nonendemic area by microscopy and molecular assays

Our study aimed to describe the occurrence of imported malaria in a nonendemic area (Parma, Italy) during the period 2000 to 2007, comparing the data obtained by microscopy and molecular assays targeting plasmodial 18S subunit rRNA gene. The prevalence of imported malaria in Parma was 21.8% by microscopy and 22.7% by polymerase chain reaction (PCR). Plasmodium falciparum accounted for 81.1% of the cases, followed by Plasmodium ovale (8.8%), Plasmodium vivax (3.8%), and Plasmodium malariae (1.9%). Mixed infections accounted for 4.4% of the cases. In this study, PCRs proved to be more sensitive and specific than microscopy and changed the picture of malaria epidemiology in Parma, detecting additional cases of malaria undiagnosed by microscopy and allowing speciation of plasmodia in cases misidentified by microscopy. Generally, imported malaria cases reflect the number of immigrants who visit their native countries, in particular, West Africa, explaining the increased prevalence of P. ovale cases among non-P. falciparum infections in Parma.     

Quinine-induced disseminated intravascular coagulation: case report and review of the literature

OBJECTIVE: To describe the clinical course of quinine-induced disseminated intravascular coagulation (DIC) and review all previous cases reported in the medical literature. DESIGN: Case report/literature review. SETTING: University teaching hospital medical ICU. PATIENTS: One patient in whom thrombocytopenia, coagulopathy, intravascular hemolysis, DIC, and acute renal failure temporally followed the ingestion of quinine. DATA SOURCES: We conducted a computerized free-text MEDLINE database search from 1969 to 2000 using the keywords quinine and thrombocytopenia, quinine and hemolytic-uremic syndrome, and quinine and disseminated intravascular coagulation. STUDY SELECTION: All reported cases and reviews of quinine-induced thrombocytopenia, hemolytic-uremic syndrome (HUS), and DIC were reviewed. DIC was distinguished from quinine-induced thrombocytopenia or quinine-induced HUS based on the presence of abnormal clotting times, elevated fibrin degradation products, and/or elevated D-dimer levels. DATA SYNTHESIS: Fifteen previous patients were found to meet the criteria for DIC temporally related to the recent ingestion of quinine. The clinical course and laboratory abnormalities documented for each case are reviewed. CONCLUSIONS: Quinine-induced DIC is a distinct clinical entity, which may present as unexplained thrombocytopenia, coagulopathy, or renal failure. In susceptible patients, the immune response to quinine may result in the production of not only anti-platelet antibodies but also antibodies against leukocytes, erythrocytes, and endothelial cells. Furthermore, the varying patterns and specificities of antibody production in an individual patient may result in a spectrum of clinical disease from mild, transient thrombocytopenia to overt intravascular hemolysis, renal failure, coagulopathy, and DIC. Early recognition of quinine-induced DIC is paramount, as this diagnosis affords a better prognosis than other adult forms of HUS or DIC.     

Clinical review: Severe malaria

Malaria represents a medical emergency because it may rapidly progress to complications and death without prompt and appropriate treatment. Severe malaria is almost exclusively caused by Plasmodium falciparum. The incidence of imported malaria is increasing and the case fatality rate remains high despite progress in intensive care and antimalarial treatment. Clinical deterioration usually appears 3–7 days after onset of fever. Complications involve the nervous, respiratory, renal, and/or hematopoietic systems. Metabolic acidosis and hypoglycemia are common systemic complications. Intravenous quinine and quinidine are the most widely used drugs in the initial treatment of severe falciparum malaria, whereas artemisinin derivatives are currently recommended for quinine-resistant cases. As soon as the patient is clinically stable and able to swallow, oral treatment should be given. The intravascular volume should be maintained at the lowest level sufficient for adequate systemic perfusion to prevent development of acute respiratory distress syndrome. Renal replacement therapy should be initiated early. Exchange blood transfusion has been suggested for the treatment of patients with severe malaria and high parasitemia. For early diagnosis, it is paramount to consider malaria in every febrile patient with a history of travel in an area endemic for malaria.     

Oliguric and non-oliguric acute renal failure in malaria in west zone of rajasthan,India-A comparative study

ObjectiveTo report a comparative clinical and histopathological study on oliguric and non-oliguric acute renal failure (ARF) in malaria.Method311 consecutive cases of malaria out of which 74 (23.79%) had ARF as per WHO criteria were conducted. Mean age was 32.58 (range 15–60 years) and male: female was 2:1.ResultMost of the cases developed ARF within 10 d of onset. 18 cases (11 falciparum, 2 mixed, 5 vivax) presented with oliguric and 56 (41 falciparum, 6 mixed, 9 vivax) with non-oliguric renal failure. Associated major manifestations were jaundice (75.68%), cerebral malaria (41.89%), bleeding manifestations (32.43%), severe anemia (27.03%), hypotension (25.68%), multi-organ failure (18.92%), severe thrombocytopenia (12.16%), and ARDS (8.11%). Kidney biopsy (n=20) showed acute tubular necrosis (n=7), Mesangioproliferative glomerulonephritis (n=4) or both (n=9). Hemodialysis was done in 8 cases of oliguric renal failure out of which 4 survived (average no. of session 2.9).ConclusionMost of the cases recovered within 3 weeks. Total mortality was 28.38% (n=21) and mortality was more in oliguric renal failure (72.22%) as compare to non-oliguric renal failure (14.29%).     

疟疾全球流行现状及我国输入性疫情分析

  目的  了解疟疾全球流行状况以及我国输入性疟疾病例流行病学特征,为输入性疟疾口岸防控政策提供科学依据。  方法  检索世界卫生组织发布的全球疟疾报告和中国知网数据库,收集2010 — 2019年全球疟疾和2017 — 2019年我国输入性疟疾资料,进行描述性研究和统计分析,研究全球疟疾流行态势和我国输入性疟疾流行病学特征。  结果  从全球疟疾风险分布和疟疾流行情况看,非洲仍然是全球疟疾疾病负担最高地区,疟疾报告病例数占全球报告病例数均在90%以上。 我国输入性疟疾病例的感染主要来源地为非洲,占87.81%,且以恶性疟为主。  结论  非洲是全球疟疾防控的重点区域。 我国大陆消除疟疾本土病例后,来自非洲的输入性疟疾,特别是恶性疟成为我国消除疟疾面临的严重挑战。 要在现有措施基础上加强口岸查验、联防联控、重点人群干预和预警监测,进一步提升输入性疟疾病例处置能力。     

Artemisinin-based combination therapies and their introduction in Japan

Artemisinin was discovered in 1971 from a herb, Artemisia annua, which had been used for more than 2,000 years in China against intermittent fever. Now, the artemisinin and its derivatives have become essential components of artemisinin-based combination therapies (ACTs). The ACTs are the recommended first-line treatments of malaria because they are effective against all four human malarias, produce rapid parasite/fever clearance, and show fewer adverse effects. Some ACTs are particularly important in cases of severe and complicated falciparum malaria, including cerebral malaria. However, neither the artemisinin and its derivatives nor any ACTs are registered in Japan. Indeed, the only licensed drugs for the treatment of malaria in Japan are quinine, mefloquine, and sulfadoxine/pyrimethamine. Although indigenous malaria has been eradicated in Japan since 1959, 60–100 imported malaria cases have been reported annually for the past decade. Some of the patients were, in fact, dying of the severe complications. Thus, the introduction of the ACTs and their application to imported malaria patients in Japan are urgently needed. A few clinical studies using the ACTs have been reported in Japan. The first application of an ACT, intramuscular artemether plus mefloquine, was reported in 1988 to be very effective against cerebral malaria with coma. Five cases with intravenous artesunate plus mefloquine were reported through 2001–2007, for severe or drug-resistant falciparum cases, resulting in successful treatment with some side effects such as hemolytic anemia or postmalaria neurological syndrome. Currently, a fixed-dose ACT, artemether–lumefantrine, is prescribed successfully for uncomplicated falciparum cases, with a limited number of recrudescences.