刚果（金）维和部队90例恶性疟临床特征分析

目的 探讨非洲刚果（金）维和部队恶性疟疾的临床特点、诊断和治疗方法,为提高治疗疟疾的疗效提供依据。方法 对2018年9月—2019年5月治疗的90例恶性疟患者的临床表现、实验室检查及治疗进行回顾性分析。结果 门诊患者给予服用双氢青蒿素哌喹片,住院治疗患者随机分为两组,一组给予青蒿琥酯静脉推注加口服双氢青蒿素哌喹片,二组给予蒿甲醚针剂肌肉注射加口服双氢青蒿素哌喹片;90例患者治疗效果均较满意,治愈率为100%,死亡率为0;门诊治疗患者中有1例复燃,住院患者2组不同治疗药物无1例复燃;平均退热时间,一组为（26.5±8.7） h,二组为（30.9±9.7） h;平均原虫转阴时间,一组为（37.4±12.2） h,二组为（41.2±11.1） h。结论 恶性疟患者临床表现多样化,部分病例缺乏典型症状、体征。门诊给予口服双氢青蒿素哌喹片,住院患者给予青蒿琥酯+双氢青蒿素哌喹片或蒿甲醚+双氢青蒿素哌喹片,可作为我刚果（金）维和部队二级医院治疗疟疾的常规方案。脑型疟等凶险发作恶性疟及症状较重者可首选青蒿琥酯作为基础治疗药物。     

陕西省97例输入性疟疾的临床特点及抗疟药物用药分析

目的 分析陕西省2018年1月—2020年9月收治的97例输入性疟疾的流行病学和临床特征,总结抗疟治疗及转归情况,为提高早期诊断、减少误诊、提高治疗效果提供经验依据。方法 回顾分析2018年1月—2020年9月陕西省传染病院收治的疟疾患者住院病例资料,对所有纳入患者的一般资料、流行病学特征、临床特征、治疗方法及疾病转归进行描述性分析。结果 2018年1月—2020年9月,陕西省传染病院收治的输入性疟疾患者97例,其中93例为外出务工的中国籍工人,4例为非洲来西安工作或留学外籍人员; 92例来自非洲,5例来自亚洲。恶性疟疾78例,间日疟15例,卵型疟4例,其中重型疟疾占11例（均为恶性疟原虫感染）;疟疾全年散发,临床表现主要为发热、畏寒、寒战、头痛、头晕、肌肉酸痛、食欲下降、恶心、呕吐、腹痛等症状。重型疟疾可发生严重肾功能异常或继发嗜血综合征;不同类型疟原虫感染采用针对性的治疗方案,19例间日疟及卵型疟中,12例予口服磷酸氯喹加磷酸伯氨喹治疗,7例予以蒿甲醚注射液治疗。78例恶性疟中,42例口服青蒿素类复方制剂,25例予蒿甲醚注射液治疗,11例重型疟疾有3例在使用青蒿琥酯注射液或蒿甲醚注射液后再口服青蒿素类复方制剂序贯治疗,所有患者疟原虫均转阴,但仍有1例间日疟复发, 3例恶性疟原虫再燃,对复发及再燃的病例予再次治疗后亦均治愈。结论 对有疟疾流行区居留史的发热患者,及时进行外周血涂片查找疟原虫有助早诊断。对确诊病例宜早采用合理、规范、足疗程抗疟药物,是有效治疗的关键。     

Malaria

Malaria is a parasitic infection of global importance. Although relatively uncommon in developed countries, where the disease occurs mainly in travellers who have returned from endemic regions, it remains one of the most prevalent infections of humans worldwide. In endemic regions, malaria is a significant cause of morbidity and mortality and creates enormous social and economic burdens. Current efforts to control malaria focus on reducing attributable morbidity and mortality. Targeted chemoprophylaxis and use of insecticide-treated bed nets have been successful in some endemic areas. For travellers to malaria-endemic regions, personal protective measures and appropriate chemoprophylaxis can significantly reduce the risk of infection. Prompt evaluation of the febrile traveller, a high degree of suspicion of malaria, rapid and accurate diagnosis, and appropriate antimalarial therapy are essential in order to optimize clinical outcomes of infected patients. Additional approaches to malaria control, including genetic manipulation of mosquitoes and malaria vaccines, are areas of ongoing research.     

Parasitic procrastination: late-presenting ovale malaria and schistosomiasis

A 29-year-old woman with ovale malaria (most likely contracted, together with asymptomatic schistosomiasis, in East Africa two years previously) had fever, nausea and confusion, jaundice, anaemia, thrombocytopenia, hyponatraemia and hypokalaemia. She was initially diagnosed with and treated for blood-smear-positive vivax malaria. Because of the unusual clinical presentation, blood was analysed by a malaria species-specific nested polymerase chain reaction (PCR) assay which identified Plasmodium ovale as the only infecting species. This case illustrates (i) that a detailed travel history remains a vital part of clinical assessment, (ii) ovale malaria can have an exceptionally long incubation period and features of a moderately severe acute infection, and (iii) PCR assay may prove a valuable adjunct to blood film examination in the diagnosis and speciation of malaria.     

长沙市2015—2019年输入性疟疾疫情分析

目的 分析2015—2019年长沙市输入性疟疾疫情,为巩固消除疟疾成果和今后的防控工作提供依据。方法 通过国家传染病报告信息管理系统和寄生虫病防治信息管理系统,收集整理2015—2019年长沙市疟疾病例信息,描述疟疾病例的流行病学特征,对疟疾诊断机构、诊断及时性、病情等情况采用χ²检验、秩和检验进行统计分析。结果 2015—2019年长沙市共报告290例疟疾病例,全部为境外输入性病例,其中恶性疟患者占74.83%;长沙市9个辖区（县、市）均有病例报告和分布,现住址为本市病例151例,外地病例139例;疟疾患者以中青年男性务工人员居多;市级医疗机构诊治病例数最多,省级医疗机构诊断率最高,省、市、县三级医疗机构初诊到诊断间隔时间差异无统计学意义（H=2.396, P>0.05）;2019年相对于2015年诊断及时性上升（H_{发病-初诊}=14.186, P<0.05; H_{初诊-诊断}=33.708, P<0.05）;疟疾重症患者（包括危重）有191例,恶性疟相对于其他疟疾患者重症率高（χ²=6.712, P<0.05）,不同病情的疟疾患者诊断及时性差异无统计学意义（Z_{发病-初诊}=-1.157, P>0.05; Z_{初诊-诊断}=-0.197, P>0.05）。结论 长沙市输入性疟疾诊断及时性有所提升,应继续做好输入性疟疾防控工作,疟疾防控关口前移。     

高颈段脊髓肿瘤及显微手术治疗(附16例报告)

目的 探讨高颈段脊髓肿瘤临床诊断、误诊原因以及显微外科手术治疗,方法 系统分析了经显微手术治疗的１６例高颈段脊髓肿瘤的临床特点及显微手术治疗效果。结果 全组无１例死亡,无致残者,疗效确切,结论 高颈段脊髓肿瘤因部位特殊,早期症状不典型,易延误诊断,确诊本病ＭＲＩ为首选,显微外科手术是目前最根本的治疗方法。     

分子生物学技术在疟疾诊断中的应用与展望

疟疾与艾滋病、结核是世界公认的危害人类生命健康的三大公共问题之一。世界卫生组织报告,2016年全球还有44.5万人死于疟疾,疟疾的早期快速诊断对于及时治疗感染病例,降低死亡率,显得尤为重要。疟原虫诊断主要分为病原学诊断、免疫学诊断和分子生物学诊断。传统病原学诊断是疟疾诊断公认的“金标准”,但是在实际的临床应用中,病原体检测较为费时费力,且受专业镜检人员匮乏,临床经验等因素限制,容易造成漏诊和误诊,已远不能满足疟疾防治工作的需要。免疫学诊断主要采用检测抗原、抗体的血清学方法,由于可用于检测的特异性抗原较少、抗原抗体反应的干扰因素较多,血清抗体产生的时间较长等因素,使疟疾诊断的准确性和及时性上还有待提高。进入21世纪,随着核酸探针、聚合酶链反应、环介导等温扩增技术、下一代测序技术等的应用,为疟原虫的实验室检测提供了新的途径,表现出了越来越高的敏感度和特异度。本文就分子生物学技术在疟疾诊断领域中的应用与展望作一综述。     

非洲输入性疟疾重症与非重症患者临床资料对照分析

目的 分析163例非洲输入性疟疾患者的临床资料,为尽早识别重症疟疾提供参考。方法 收集广州医科大学附属市八医院 2018年1月—2020年11月收治的163例非洲输入性疟疾患者临床资料,回顾性分析患者一般情况、临床症状、实验室检查、治疗及预后。结果 本研究共纳入163例患者,其中重症组37例,非重症组126例;平均年龄（37.90 ± 10.17）岁,男性患者147例（90.2%）,中国籍患者132例（81.0%）,既往有基础疾病患者15例（9.2%）;感染虫种以恶性疟原虫为主,144例（88.3%）。与非重症组相比,重症组患者的乳酸、降钙素原、白细胞计数、中性粒细胞计数、红细胞分布宽度变异系数、血小板平均体积、血小板分布宽度、凝血酶原时间、总胆红素、丙氨酸氨基转氨酶、天门冬氨酸氨基转氨酶、碱性磷酸酶、乳酸脱氢酶、三酰甘油、尿素、肌酐和胱抑素C均升高（P<0.05）,红细胞计数、血红蛋白、红细胞压积、血小板、白蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白和载脂蛋白AI均降低（P<0.05）。经积极治疗,重症组患者死亡1例,其余均治愈出院。结论 非洲输入性疟疾患者以恶性疟原虫感染为主。恶性疟疾发展成重症比例高,死亡率高。疟疾患者的血常规、乳酸、降钙素原、血脂、凝血功能以及肝肾功能的变化对重症疟疾有很好的预警作用,有助于尽早识别重症疟疾,提高治愈率,降低死亡风险。     

Emergency in malaria

Malaria is still the most prevalent and devastating parasitic disease worldwide. In recent years drug resistance Plasmodium falciparum malaria has returned to most of the tropical countries of the globe with a vengeance. Due to various atypical manifestations the diagnosis has become confusing and hence the treatment delayed leading to various complications and increased mortality and morbidity. Patient presents with features of severe complicated malaria with multiorgan involvement in the form of malarial crisis needs emergency management in ICU. All fever cases with possible malaria should be investigated and to be treated with intravenous quinine/artimisinine pending confirmation of diagnosis. Any emergency situation that develops during treatment should be treated aggressively as medical emergency.     

非洲疟疾诊治分析

目的了解非洲疟疾的高发病率及临床特点,提高赴非洲工作的医务人员诊治非洲疟疾的警觉性,防止输入性疟疾在国内的传播。方法对赴非洲加蓬医疗队工作4年期间5042例内科门诊疟疾占内科门诊病例的比率、临床表现,不同药物治疗方案的疗效进行观察、统计。结果加蓬全年均有疟疾传播,疟疾在内科门诊发病比率年平均是17.5%,发病比率逐月有所不同。绝大多数病例缺如典型的、规则的间歇性发作,其来势凶猛,不规则持续发热,体温在38.5～39.9℃者占72%。除发热外其临床表现多样化,涉及胃肠型、黄疸肝炎型、肾炎型、肺型、厥冷型等。以青蒿素为基础的联合药物是治疗非洲疟疾的最佳方案。结论非洲疟疾绝大多数是恶性疟,且发病率很高,发热不规则,临床表现多样化。赴非洲工作的医务人员对此必须充分认识,采用最佳治疗药物,否则极易贻误病情,同时应时刻防止输入性疟疾在国内传播。     

河北省1例输入性恶性疟死亡病例调查

目的 报告2017年河北省1例输入性恶性疟死亡病例的调查情况,积累重症疟疾的救治经验,避免恶性疟死亡病例的再次发生。方法 收集患者就诊的各医疗机构的门诊、住院诊治记录和个案流行病学调查资料,并进行分析汇总。结果 该患者为非洲输入性恶性疟病例,曾在安哥拉务工100 d。自述在国外期间未曾患有疟疾。回国后当天即出现发热症状,发病后第4天到某社区卫生院就诊,给予对症治疗,无好转。再到定州市医院就诊,未查到具体病因。后经河北省胸科医院、河北医科大学第二医院转诊,发病后第5天在石家庄市第五医院确诊。该患者从初诊到确诊辗转了5家医疗机构,病情发展迅速,在发病后第7天、确诊后第3天因病情凶险,持续恶化,经抢救无效死亡。患者死于恶性疟与多器官功能衰竭。结论 疟疾病例就诊意识偏低和医疗机构诊治能力不足可能是本死亡病例发生的主要原因。应进一步做好前往疟疾流行区人员的健康教育,增强人群的疟疾求诊意识,提高医疗机构的疟疾诊治能力,尤其是重症疟疾病例的救治水平。     

西安市某医院2006—2021年输入性疟疾患者的流行病学及临床特征分析

目的 回顾性分析2006—2021年西安市某医院收治输入性疟疾患者的流行病学及临床特征。方法 详细采集2006年1月—2021年12月空军军医大学第二附属医院传染科收治的137例输入性疟疾患者的临床资料（从流行病学、临床分型、合并症、治疗及预后等方面分析其临床特征）。结果 纳入患者中有3例外籍人员,134例中国籍人员,患者发病前多有非洲或东南亚国家旅居史。恶性疟 111例（其中重型疟疾26例）、间日疟4例、卵型疟2例、三日疟2例、未分型18例。13例患者存在意识障碍（考虑脑型疟）,25例合并急性肾损伤,17例合并肺炎,4例因多脏器功能衰竭而死亡。65例（47.45%）患者病程中红细胞计数及血红蛋白低于正常下限,97例（70.80%）患者血小板低于正常下限,尿蛋白阳性者57例（41.61%）。71例（51.82%）患者使用抗疟药1 d后体温降至正常,35例（25.55%）患者2 d后体温降至正常,其余31例（22.63%）患者3~5 d后体温降至正常。126例患者治愈出院,复查血涂片疟原虫阴性;5例患者再燃;2例患者复发;4例患者死亡。患者平均住院时间8 d,平均住院费用9 261元,其中28例患者住院天数大于10 d,其住院治疗费用平均在2.04万元。结论 境外输入性疟疾仍是目前西安市定点医院收治的主要人群。掌握输入性疟疾的不同分型及重症疟疾发病特点,对指导临床医师早诊早治,提高救治水平具有重要意义。     

杭州市西溪医院66例输入性疟疾患者临床特征

目的 分析杭州市西溪医院2014年2月-2019年12月收治的疟疾患者临床资料及药物治疗情况,为临床早期诊断、评估轻重以及治疗提供参考数据,促进临床合理用药.方法 收集2014年2月—2019年12月收治入院的66例疟疾患者资料,分为轻症组和重症组,对两组患者的实验室检测指标结果、药物使用情况进行比较,并采用多因素二元...     

Current clinical presentation of malaria in Enugu, Nigeria

This study examined the malaria situation in a malarial endemic area of Nigeria. Structured questionnaire was applied to 300 doctors practising in Enugu urban, Nigeria and confirmation of the clinical diagnosis by laboratory technique was done using 468 patients. The result shows a high prevalence of Plasmodium falciparum infection (96.4% in children, 87.0% in adults). Malaria positivity rate was 51.9% in children and 42.8% in adults. Fever, vomiting and anorexia were the commonest malaria symptoms in children, while headache, fever, chills and rigors were the commonest malaria symptoms in adults. The diagnostic practice of the doctors was clinical. Fever, vomiting and cough were found to be more associated with malaria parasitaemia in children, while in adults fever was found to be more associated with malaria parasitaemia. Chloroquine and sulphadoxine-pyrimethamine were the commonest drugs used for treating uncomplicated malaria, while quinine was the commonest drug used for treating severe malaria.     

急性不典型重症戊型肝炎延误诊断一例分析

目前,我国急性戊型肝炎的发病率呈上升趋势,且临床患者均为散发病例。此时,若其症状不典型,则极易发生漏诊或误诊。急性戊型肝炎多具有起病急、病情重的特点,如果治疗不及时,部分患者可迅速发展为急性重症型肝炎,甚至出现肝功能衰竭、肝性脑病,病死率较高。本文分析1例急性不典型重症戊型肝炎致肝性脑病发作患者的诊治过程,该患者曾先后诊断为“急性胃肠炎”“阑尾炎”,虽经抗感染等治疗,病情却呈进行性加重,临床医师由于对该病认识与分析不足,导致诊断延误,最终病情急剧恶化,出现肝性脑病。本例患者提示对于临床上有消化道症状的患者,不仅要做肝功能检查,还要及早做肝炎病毒学检查,以确保早期诊治。     

Comparison of clinical, microscopic and rapid diagnostic test methods in the diagnosis of Plasmodium falciparum malaria in Enugu, Nigeria

OBJECTIVE: To compare the use of clinical, microscopic and immunochromato-graphic methods in the diagnosis of Plasmodium falciparum malaria. METHODS:Children with history of fever were consecutively recruited. Information on personal characteristics, and clinical features were obtained with the parental consent before enrolment. Malaria parasite density was done with quantitative microscopy, as well as specie identification in both local and reference laboratories. Rapid diagnostic test (RDT) kits were also used for parasite detection. RESULTS: Eighty three children had clinical diagnosis of malaria, while the remaining 6 had other diagnoses. On microscopy 89 and 26 patients had parasitaemia by the local and reference laboratories respectively. With the RDT, 15 patients had parasitaemia with corresponding minimum densities of 1200 and 716 parasites per ul from the local and reference laboratories. The sensitivity and specificity of the RDT to the reference laboratory were 42.31% and 93.65% respectively, while concordance was 57.69% for RDT, 30.49% for clinical diagnosis (all symptoms), 43.75% for clinical diagnosis (fever alone), and 29.21% for local laboratory. CONCLUSION: There was a significant deficiency in malaria diagnosis using any of the methods alone. For reliable diagnosis of malaria a combination of the methods of diagnosis is recommended. Degradation of the RDTs might have contributed to its low sensitivity. Training and better quality assurance should be established for the medical and laboratory workers in order to improve malaria diagnosis.     

Clinical profile of falciparum malaria in a tertiary care hospital

Falciparum malaria presents with protean manifestations and is associated with a variety of complications and has a high mortality. One hundred and fifty-eight consecutive cases of falciparum malaria were studied with respect to the clinical presentation, complications, and response to treatment. The mean age of patients was 38.60 +/- 15.45 years and majority of them were males i.e., males being 110 (69.62%) and females being 48 (30.37%). The commonest presenting manifestations were fever with chill and rigor (98.10%), altered sensorium (48.10%), algid malaria (18.35%), and jaundice (27.21%). The other presenting features being oliguria (6.96%) and bleeding manifestations due to disseminated intravascular coagulation (DIC) (4.43%). The frequently encountered complications were anaemia (74.68%), jaundice (40.50%), cerebral malaria (45.56%), thrombocytopenia (40.50%) and renal failure (24.68%). Most of the patients i.e., 126 (79.74%) recovered with treatment and 32 (20.25%) succumbed. Higher mortality was associated with higher parasite count, presence of complications like anaemia, jaundice, renal failure, DIC, adult respiratory distress syndrome (ARDS), and septicaemia. Most of the deaths were encountered in patients where there was delay in clinical diagnosis, in the pre-hospital phase, and consequent presentation in multiorgan failure. Early diagnosis and institution of specific therapy were rewarding in the remaining patients in this series.     

重症出血性脑梗死相关危险因素研究

目的探讨重症出血性脑梗死患者的发生、发展、相关危险因素及临床诊治方法,提高临床诊治水平。方法回顾性分析我院2005年1月至2009年6月收治的43例重症出血性脑梗死患者的临床资料。结果本组43例患者经过临床治疗好转37例,死亡6例,其中3例死于脑疝,2例死于多脏器衰竭,1例死于心肺功能不全,死亡率为13.9%;其中内科保守治疗38例,外科手术治疗5例;好转37例患者住院时间18~62 d,平均31.4 d。结论重症出血性脑梗死患者病情发展迅速、转变快、死亡率高,CT及MRI检查是重要辅助确诊手段,而在急性期进行及时的降低颅内压和脑神经保护措施对降低死亡率、改善患者预后十分重要。     

The pattern of bacteraemia in children with severe malaria

Bacteraemia is a recognised complication of severe malaria and may increase mortality. We determined 1) the rate and pattern of bacteraemia in children with severe malaria; 2) the impact of bacteraemia on case-fatality rate; and 3) the rate and pattern of bacteraemia in following blood transfusion for severe malarial anaemia. For the first two objectives, a prospective study was undertaken involving children admitted consecutively to the Malaria Research Project ward between February 1996 and June 1999. Blood culture was performed on admission. Independent associations with bacteraemia and mortality were determined by logistic regression. Of 701 children with a final diagnosis of severe malaria, 36 (5.1%) had bacteraemia. A wide range of bacteria was isolated and the commonest was non-typhoidal Salmonella (NTS: n=18 or 50% of all isolates). The rate of bacteraemia was significantly higher in children with severe malarial anaemia without coma (11.2%) than in children with cerebral malaria without anaemia (3.2%) and this was due to the significant association of NTS bacteraemia with severe malarial anaemia (p<0.001). The overall case-fatality rate was 15% and was higher in children with bacteraemia (22%) but this difference was not significant. For the third objective, data were collected retrospectively of all children who received a blood transfusion in the paediatric department from March 1996 until May 1997 inclusive. A total of 1712 children received a blood transfusion. Of these, 243 (14.2%) had a blood culture taken for the investigation of fever following transfusion; a pathogen was grown from 60 (24.7%). NTS bacteraemia accounted for 76.3% of all bacteraemia cases. NTS bacteraemia is a common complication of severe malarial anaemia.     

江苏省11例输入性重症疟疾病例分析

目的 对江苏省11例输入性重症疟疾病例进行分析,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2019年江苏省11例重症疟疾病例传染病报告信息管理系统和寄生虫病防治信息管理系统的个案信息、流行病学调查报告以及住院病历,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 11例重症疟疾病例中恶性疟10例、卵形疟1例,均为境外输入性病例,在境外生活时间最短22 d,最长1 070 d,在国外期间有4例曾患过疟疾。10例恶性疟重症病例均在回国后一个月内发病,其中有 3例在回国当天就发病。1例卵形疟重症病例在回国后134 d才开始发病。11例重症疟疾病例发病至就诊平均时间为2.5 d,就诊至确诊平均时间为1.81 d。重症表现为昏迷或休克3例、重度贫血3例、急性肾功能衰竭4例、急性呼吸窘迫综合征1例。1例卵形疟由于出现自发性脾破裂引起重度贫血。除1例卵形疟病例给予双氢青蒿素哌喹片加服伯氨喹片治疗外,其余10例恶性疟重症病例均采用青蒿琥酯注射抗疟治疗, 接受抗疟治疗后均痊愈出院。11例重症病例,住院天数最短9 d,最长40 d,平均22.64 d;住院费用最少9 270元,最多177 174元,平均81 520.76元。结论 应加强多部门合作,提高患者及时就诊意识;加强医务人员疟疾专业知识和业务的培训,尽早发现输入性疟疾病例并及时治疗,防止因延误诊断造成的重症疟疾。