努力提高脑型疟的诊治水平

努力提高脑型疟的诊治水平张家埙脑型疟是指由恶性疟原虫感染引起，而非其他原因导致昏迷的恶性疟患者。重症疟疾中以脑型疟最容易致死，据世界卫生组织报告，它约占恶性疟住院病例的１０％和死亡数的８０％。国内因近年流动人口大增，输入性病例日益多见，尤其是援外人员...     

血脑屏障的破坏是脑型疟形成的标志吗?

在发展中国家 ,脑型疟疾是一个主要的杀手 ,但是对其病因知道的仍然很少。在此对尸解、体外试验及动物模型研究中提供的最新证据作一介绍 ,以阐明血脑屏障的破坏在脑型疟疾中的显著作用 ,在重症疟疾中 ,血脑屏障完整性的破坏将导致大脑血管的渗漏。了解该病如何发生以及导致昏迷的病因 ,以便为选择脑型疟疾的对症治疗提供对策参考     

血脑屏障的破坏是脑型疟形成的标志吗？

在发展中国家，脑型疟疾是一个主要的杀手，但是对其病因知道的仍然很少。在此对尸解、体外试验及动物模型研究中提供的最新证据作一介绍，以阐明血脑屏障的破坏在脑型疟疾中的显著作用，在重症疟疾中，血脑屏障完整性的破坏将导致大脑血管的渗漏。了解该病如何发生以及导致昏迷的病因，以便为选择脑型疟疾的对症治疗提供对策参考。     

脑型疟免疫病理学机制的研究进展

了解脑型疟发病机制最新进展，可为防治脑型疟、降低死亡率提供依据。研究发现鼠脑型疟是一种多因素参与的致命性的免疫病理性疾病，中枢神经系统血脑屏障渗透性增加、星形胶质细胞变性导致其支持功能的丧失、小胶质细胞与淋巴细胞分泌的各种细胞因子和单核／巨噬细胞相结合共同促使中枢神经系统功能紊乱，诱发脑型疟。在探讨人类脑型疟致病机制时应考虑中枢神经系统内胶质细胞和细胞因子的作用。     

脑型疟小鼠小胶质细胞的活化特征分析

目的 利用血脑屏障分隔小胶质细胞与外周巨噬细胞,探讨小胶质细胞在实验型脑型疟(experimental cerebral malaria,ECM)发生中的活化特征.方法 利用依文思兰渗出法确定ECM小鼠血脑屏障开放时间,在不同感染时间点,采用流式细胞技术和间接免疫荧光法检测小胶质细胞的活化特征,采用实时荧光定量PCR技...     

脑型疟死亡一例分析

病例　范某 ,女 ,2 6岁 ,原籍广西北海 ,于 1999年加入冈比亚共和国国籍。 2 0 0 0年 6月在冈比亚居住过 ,其他时间居住英国。2 0 0 1年 12月 11日回原籍探亲 ,其间 12月 18日去广州办事 ,12月 2 2日返回原籍北海。住房为 2层砖混结构 ,防蚊条件好 ,平均气温为 8～ 16℃。其亲属否认曾有疟史。 2 0 0 1年12月 2 3日患者自觉不适 ,约 2 1时到市某医院就诊后自觉有所好转。 2 4日症状反复 ,门诊检查 :体温 39℃、血压 10 0 /70mm Hg,咽部充血 ,心律齐、 10 8次 /min,心、肺正常 ,腹软 ,未触及肝、脾 ,右下腹有微压痛 ,无神经症状 ,白细胞 35 …     

脑型疟相关粘附因子

细胞粘附是脑型疟形成的关键因素之一。本文对与粘附作用相关的主要配体和受体的基本结构、生理功能、在脑型疟形成中的作用等进行了概述。     

中国脑型疟患者恶性疟原虫分离株裂殖子表面蛋白…

目的：为设计研制安全和的人脑型疟疫苗提供进一步科学依据。方法：应用多聚酶锭反应＊（ＰＣＲ）技术对中国５例脑型疟患者恶性疟原虫云南省勐腊县勐罕ＣＭＨ／ＹＮ分离株和云南省盈江县农场ＣＹＪ／ＹＮ分离株基因组ＤＮＡ裂殖子表面蛋白（ＭＳＰ１）第１３－１７区基因进行扩增，，将扩增产物分别经ＥｃｏＲＩ和ＫｐｎＩ双酶切后，回收的ＭＳＰ１第１６－１７区基因分子定向克隆Ｍ１３ｍｐ１８和Ｍ１３ｍｐ１９载体，按Ｓａｎｇｅ     

大连地区首例恶性疟死亡个案调查报告

本文报道了大连地区首例恶性疟死亡病例的调查情况。     

Cerebral malaria and immunogenetics

Cerebral malaria depends largely on the capacity of Plasmodium falciparum infected red blood cells to adhere to the endothelia of microvessels, leading to their occlusion. The most important players include receptors expressed on the surface of the endothelial cell and known to interact with the parasite, cytokines modulating the expression of these adhesion molecules and nitric oxide (NO). Platelets, monocytes and lymphocytes have the ability to adhere to these endothelial receptors and to one another, leading to a more complex situation and an increase in the degree of vessel occlusion. The polymorphism of all these molecules, implicated either in adhesion, in modulation of this adhesion or activation of the expression of diverse endothelial mediators should be an important field of study. Polymorphism of five of these molecules has been explored so far: ICAM-1, TNF-alpha, IL-1-beta, inducible NOS and complement receptor-1 (CR-1). To these studies can be added those concerning mannose binding protein (MBP), a protein playing a role in innate immunity, and the class-I antigen HLA-B53. To date, the only clear cut result concerns TNF-alpha. With the other polymorphisms, either no association is found (IL-1RA, CR-1, MBP), or the results are geographically heterogeneous (ICAM-1, HLA-B53), or contradictory (iNOS2). Most often, the candidate gene approach has been followed, as part of case control studies. One of the main problems in this approach is the difficulty of establishing the control cohort. This difficulty disappears in family studies, which include their own controls. So far, the only results based on complex segregation analysis have been focused on parasite multiplication and not on cerebral malaria.     

Severe anaemia in children living in a malaria endemic area of Kenya

Severe anaemia is an important cause of morbidity and mortality in African children, but the causes, particularly falciparum malaria, are difficult to determine. We assessed the contribution of falciparum malaria to anaemia in Kenyan children by clinical examination and measurement of parasitaemia and haemoglobin (Hb) concentration in 559 children in the community and in 2412 children admitted to Kilifi district hospital during a 2‐year period. We also attempted to characterize severe malarial anaemia by examining the causes and pathophysiology of anaemia in 101 children admitted with Hb concentration 50 g/l during a 1‐year period. Plasmodium falciparum infection was associated with reduced Hb concentration in children in the community and in those admitted to hospital irrespective of diagnosis. Falciparum malaria was the primary cause in 46 cases (46%) of severe anaemia admitted to hospital. There was no difference in the frequency of haemolysis or dyserythropoiesis in the children with malarial anaemia and those with anaemia from other causes, such as iron deficiency or sickle cell disease. The mortality rate in the children with severe malarial anaemia was 8.6% compared with 3.6% in children with severe anaemia due to other causes. Falciparum malaria does not present with a characteristic clinical or haematological picture, but is a major cause of the morbidity and mortality in children with severe anaemia who live on the Kenyan coast, a malaria endemic area.     

Severe anaemia in Zambian children with Plasmodium falciparum malaria

BACKGROUND: Severe anaemia and cerebral malaria are highly prevalent complications of Plasmodium falciparum malaria among African children. The mechanisms of severe malarial anaemia, and the relative importance of this condition in comparison to cerebral malaria, are not known for many regions of Africa. METHODS We reviewed the records of 6200 children up to 6 years of age admitted to one rural Zambian hospital between 1994 and 1996. Severe malarial anaemia was defined as an haemoglobin concentration < 5.0 g/dl in a patient with asexual forms of P. falciparum in the peripheral blood. Cerebral malaria was defined as impaired consciousness (Blantyre coma score < 5) not attributable to any other cause in a patient with a positive malaria smear. RESULTS Severe malarial anaemia was found in 590 children (9.5% of paediatric admissions) and strictly defined cerebral malaria occurred in 286 children (4.6% of paediatric admissions); 98 of these patients had the combination of both complications. Severe malarial anaemia correlated strongly with the degree of parasitaemia, with malnutrition as indicated by low weight for age, with absence of fever and with presentation late in the malaria season. In comparison, patients with cerebral malaria were more often febrile and presented earlier in the malaria season. The case fatality rate of severe malarial anaemia (0.088) was about half that of cerebral malaria (0.189), but because severe malarial anaemia was more common, these two forms of complicated malaria were implicated in similar numbers of in-hospital paediatric deaths. CONCLUSION Severe anaemia is a more common complication of P. falciparum malaria in hospitalized Zambian children than cerebral malaria and is associated with a similar number of deaths. Malnutrition and changes in immune response patterns due to prolonged exposure to P. falciparum may contribute to the development of this complication.     

Origin and prevention of airport malaria in France

Summary Since 1969, 63 cases of airport malaria have been reported in Western Europe, 24 of which occurred in France. Most were due to Plasmodium falciparum . In 1994, 7 cases occurred in and around Roissy Charles de Gaulle airport (CDG), showing 4 types of contamination: among employees working on airstrips or opening containers, among residents living near the airport, among people living at some distance from the airport after a secondary transport of vectors, and by vectors transported in luggage. In-flight or stop-over infection is not considered as airport malaria. The infective anophelines originated from airports where malaria transmission occurs, mostly in subsaharan Africa. A tentative list is given taking into account aerial traffic with France. Surveys in the airports of Dakar (Senegal), Cotonou (Benin), Abidjan (Cote d'Ivoire) and Yaoundé (Cameroun) found potential vectors in all of these from July to September. After 1994, the Contrôle Sanitaire aux Frontières (CSF) in charge at CDG concentrated its efforts on the flights at risk, as well as information and sensitization of airline companies, which resulted in 73% and 87% of the flights at risk being properly disinsected in 1995 and 1996. Despite pyrethroid resistance in Anopheles gambiae s.s . in West Africa, the efficacy of aircraft spraying with permethrin aerosols is still acceptable. However, surveillance of resistance should be improved and search for nonpyrethroid insecticides suitable for aircraft strongly encouraged.     

Developmental impairments following severe falciparum malaria in children

OBJECTIVE: Neurological deficits are reported in children after cerebral malaria (CM) but little is known about the prevalence and characteristics of persisting neurocognitive consequences. The prevalence of developmental impairments following other complications of falciparum malaria, such as multiple, prolonged or focal seizures, is not known. Thus, our objective was to investigate the long-term developmental outcome of CM and malaria with complicated seizures (M/S). METHODS: We followed up a cohort of children previously exposed to CM or M/S and children unexposed to either condition. All children between 6 and 9 years of age, exposed to CM, and an equal number of children exposed to M/S were identified from databases of hospital admissions from 1991 to 1998. The unexposed group was randomly selected from a census database. The children's performance was measured using assessments of cognition, motor, speech and language, hearing and vision. A parental questionnaire was used to identify children with epilepsy. RESULTS: CM group scores were significantly lower than unexposed group scores on the assessments of higher level language (adjusted mean difference -1.63, 95% CI: -2.99 to -0.27), vocabulary (-0.02, 95% CI: -0.04 to -0.01), pragmatics (OR 2.81, 95% CI: 1.04-7.6) and non-verbal functioning (-0.33, 95% CI: -0.61 to -0.06). The areas of significantly reduced functioning for the M/S group were concentrated on phonology (OR 2.74, 95% CI: 1.26-5.95), pragmatics (OR 3.23, 95% CI: 1.2-8.71) and behaviour (OR 1.8, 95% CI: 1.0-3.23). The performance of the active epilepsy group was significantly poorer than that of the group without epilepsy on the tests of comprehension, syntax, pragmatics, word finding, memory, attention, behaviour and motor skills. CONCLUSIONS: CM and M/S are associated with developmental impairments. If these impairments persist, this may have implications for least 250,000 children in Sub-Saharan Africa each year. Active epilepsy significantly increases the risk of cognitive and behavioural problems in children with a history of severe malaria.     

Severe chronic diarrhea and maculopapular rash: a case report

Systemic mastocytosis (SM) is a heterogeneous disease of the bone marrow characterized by abnormal growth, accumulation and activation of clonal mast cells (MCs). We report a case of SM with multiorgan involvement. A 30-year-old man presented with diarrhea, flushing, maculopapular rash with itching and weight loss. The upper and lower gastrointestinal endoscopies showed macroscopic involvement of stomach and duodenum; mucosal samples from stomach, duodenum, colon and distal ileum showed mucosal inf iltratio...     

输入性恶性疟1例血液学筛查并文献复习

本文报道1例输入性恶性疟的血液学筛查和原虫形态学特征, 并结合文献进行复习。     

Cytokine levels during mild and cerebral falciparum malaria in children living in a mesoendemic area

Summary Cell-mediated immunity and cytokines are probably involved in the pathogenesis of malaria. To investigate the role and the activity of different immune cells, we measured levels of tumour necrosis factor-(TNF-α), gamma interferon (IFN-γ) and several interleukins (IL-2, IL-4, IL-6 and IL-10) in children with mild (MM) and cerebral (CM) Plasmodium falciparum malaria and compared them with those of healthy children from Guadalupe - Lobata District, St. Tomé Island, where malaria is mesoendemic. Both groups of patients had significantly higher levels of IL-6, IL-10 and TNF-α than controls. For IL-2, IL-4 and IFN-γ we found no difference between the groups. However, 24 h after admission the levels of IL-10 and IL-6 were significantly higher in CM than in MM patients, although 7 days after treatment they returned to normal levels, similar to those found in control children. Therefore, TNF-α IL-6 and IL-10 increase during Plasmodium falciparum attacks in all children, not only in those with cerebral malaria. This finding suggests the activation of the monocyte/macrophage system during the early stage of clinical malaria.     

Epidemiology of congenital malaria in Nigeria: a multi-centre study

Objective To determine the burden of congenital malaria in newborns in Nigeria. Methods In a prospective multi‐centre study, 1875 consecutive mother–baby pairs were enrolled over a continuous 12‐month period. Blood smears were prepared from mothers, neonates, placental aspirates and cord blood within 4 h of delivery. Outcome variables were patent parasitaemia in the mother, placenta, cord and neonate in addition to maternal and neonatal haematocrit. Results Patent parasitaemia was detected in 95 neonates (5.1%). The occurrence varied between study centres, but was found year round in all sites. The mean parasite density among infected neonates was low (48 asexual forms per μl, range 8–200/μl). Maternal and placental parasitaemia were the most important risk factors for patent neonatal parasitaemia (P < 0.0001). Spontaneous clearance of parasitaemia occurred in 62.1% of neonates before day 2. 33.7% were symptomatic within 3 days of birth. Conclusion Congenital malaria is often asymptomatic, clears spontaneously and may not warrant treatment. However, newborns with unexplained fever and refusal to feed in malaria endemic areas should be tested for malaria.