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The treatment of severe falciparum malaria 总被引:1,自引:0,他引:1
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Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria 总被引:7,自引:0,他引:7
Reyburn H Mbatia R Drakeley C Bruce J Carneiro I Olomi R Cox J Nkya WM Lemnge M Greenwood BM Riley EM 《JAMA》2005,293(12):1461-1470
Context There are concerns that malaria control measures such as use of insecticide-treated bed nets, by delaying acquisition of immunity, might result in an increase in the more severe manifestations of malaria. An understanding of the relationships among the level of exposure to Plasmodium falciparum, age, and severity of malaria can provide evidence of whether this is likely. Objective To describe the clinical manifestations and case fatality of severe P falciparum malaria at varying altitudes resulting in varying levels of transmission. Design, Setting, and Patients A total of 1984 patients admitted for severe malaria to 10 hospitals serving populations living at levels of transmission varying from very low (altitude >1200 m) to very high (altitude <600 m) in a defined area of northeastern Tanzania, studied prospectively from February 2002 to February 2003. Data were analyzed in a logistic regression model and adjusted for potential clustering within hospitals. Main Outcome Measures Specific syndromes of severe malaria; mortality. Results The median age of patients was 1 year in high transmission, 3 years in moderate transmission, and 5 years in low transmission areas. The odds of severe malarial anemia (hemoglobin <5 g/dL) peaked at 1 year of age at high transmission and at 2 years at moderate and low transmission intensities and then decreased with increasing age (P = .002). Odds were highest in infants (0-1 year: referent; 2-4 years: odds ratio [OR], 0.83; 95% confidence interval [CI], 0.72-0.96), 5 to <15 years: OR, 0.44; 95% CI, 0.27-0.72; 15 years: OR, 0.44; 95% CI, 0.27-0.73; P<.001) and high transmission intensity areas (altitude <600 m: referent; 600 m to 1200 m: OR, 0.55; 95% CI, 0.35-0.84; >1200 m: OR, 0.55; 95% CI, 0.26-1.15; P for trend = .03). The odds of cerebral malaria were significantly higher in low transmission intensity areas (altitude of residence <600 m: referent; 600 m to 1200 m: OR, 3.17; 95% CI, 1.32-7.60; >1200 m: OR, 3.76; 95% CI, 1.96-7.18; P for trend = .003) and with age 5 years and older (0-1 year: referent; 2-4 years: OR, 1.57; 95% CI, 0.82-2.99; 5 to <15 years: OR, 6.07; 95% CI, 2.98-12.38; 15 years: OR, 6.24; 95% CI, 3.47-11.21; P<.001). The overall case-fatality rate of 7% (139 deaths) was similar at high and moderate levels of transmission but increased to 13% in low transmission areas (P = .03), an increase explained by the increase in the proportion of cases with cerebral malaria. Conclusions Age and level of exposure independently influence the clinical presentation of severe malaria. Our study suggests that an increase in the proportion of cases with more fatal manifestations of severe malaria is likely to occur only after transmission has been reduced to low levels where the overall incidence is likely to be low. 相似文献
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Malaria is the most important parasitic disease of man. It is the protozoan infection of RBCs transmitted by bite of blood feeding female anopheline mosquito. Until the 19th century malaria was found throughout Europe, North America and Russia. Since then, it has been eradicated from these areas but in tropics though initial efforts of eradication had been successful, there has been resurgence of disease accompanied by increasing resistance of the anopheline vector to insecticide and of the parasite to antimalarial drugs. We report two cases of falciparum malaria in which there was co-existent vivax malarial infection. These two cases were both exposed to highly endemic zone for malaria. 相似文献
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45例重症恶性疟疾临床分析 总被引:2,自引:0,他引:2
目的探讨重症恶性疟疾的临床特点及防治.方法对45例病例的临床资料进行回顾性分析. 结果45例均为外来人口恶性疟疾,以脑型疟居多,占62.2%;黑尿热、妊娠疟疾等分别占13.3%和6.7%.严重并发症是急性肾功能衰竭、呼衰、多器官功能衰竭和冠心痛,经抗疟治疗和辅助治疗后死亡4例,治愈41例,治愈率为91.1%.结论恶性疟痰危重病症原虫治疗是根本措施,及时识别和合理治疗并发症是关键,加强对流动人口疟疾管理,预防为主要手段. 相似文献
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目的 研究输入性恶性疟疾重症病例的临床表现、诊断及治疗。方法 对2009年11月—2018年3月收治的89例输入性恶性疟疾重症病例的流行病学资料、临床特点、诊断方法、治疗措施进行总结。统计流行病学资料;统计发热、寒战、肌肉疼痛、头痛等患者占所有病例的百分比;统计贫血、黄疸、少尿或无尿、肝脾肿大、意识障碍等患者占所有病例的百分比;依据WHO第三版重症疟疾标准对所有病例进行评估;统计各分型病例占所有病例的百分比;了解显微镜下疟原虫密度、形态;采用疟疾快速诊断试剂(胶体金法),进行检测,并与显微镜镜检结果进行比较分析;对照青蒿素类药物蒿甲醚与青蒿琥酯的疗效;总结血液透析、血液灌流、血浆置换、血浆吸附例数。结果 全部病例均有国外生活史及蚊虫叮咬史。所有患者均有不同程度的发热(100.0%),寒战、肌肉疼痛、头痛患者分别占所有病例的96.6%、94.4%、92.1%;贫血、黄疸、少尿或无尿、肝脾肿大、意识障碍分别占100.0%、79.8%、30.3%、28.1%、11.2%;分型以急性肝损伤、高原虫血症、急性肾功能衰竭多见,分别占79.8%、62.9%、30.3%。所有病例外周血涂片入科前均查到疟原虫,环状体(小滋养体)73例(82.0%),大滋养体14例(15.7%),配子体2例(2.3%)。抗原检测(快速诊断试验,RDT)36例(入科治疗后),阳性25例(其中镜检阴性4例),阴性11例。疟原虫镜检阳性32例。应用蒿甲醚后7 d镜检阴转率93.8%,青蒿琥酯7 d镜检阴转率100.0%。血液透析、血液灌流、血浆置换、血浆吸附等支持对症治疗86例痊愈。3例在入院前因诊断不清而延误治疗,导致入院后经抢救无效死亡。结论 流行病学史的详细调查对早期诊断及治疗预后至关重要;镜检与RDT检测结果要依据治疗前后结果进行综合分析。青蒿素类抗疟治疗安全、有效,无抗药性,重症病例青蒿琥酯首选。血液透析、血液灌流、血浆置换、血浆吸附及支持对症治疗,对抢救重症疟疾患者效果良好。 相似文献
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T M Davis 《The Medical journal of Australia》1989,150(6):348-349
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We describe the haemodynamic and oxygen transport response in a patient undergoing exchange transfusion for severe falciparum malaria. We found that exchange transfusion produced a significant increase in left ventricular stroke work index, systemic oxygen delivery and oxygen consumption. This potentially beneficial effect of exchange transfusion has not been reported previously. 相似文献
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Rajput R Singh H Singh S Meena Tiwari UC 《Journal of the Indian Medical Association》2000,98(10):612-614
Malaria, a major killer of mankind, apart from classical ague presentation, may present with respiratory manifestations. This may be misdiagnosed and important time may be lost in instituting antimalarials leading to higher morbidity and mortality. Present work was undertaken to study the clinical presentations of malaria with special reference to respiratory system and to evaluate the effect of antimalarials to such atypical presentation. One hundred slide positive cases of malaria were taken and detailed for respiratory involvement. Response to antimalarials was seen in these cases and associated complications (if any) were looked for. Mean age of the cases was 29.3 years with a male predominance. Positivity of peripheral smear read as: P vivax(53%), P falciparum (36%) and mixed infection (11%). Twenty-six patients had presented with respiratory manifestations-bronchitis (15), pneumonia (4), asthmatic bronchitis (1), adult respiratory distress syndrome (ARDS) (4) and pulmonary tuberculosis (2). Of these 26 cases, presenting symptoms noticed were cough (77%), dyspnoea (32%), expectoration (29%) and chest pain (15%). Twenty-five (96%) of these 26 patients were positive for P falciparum. Response to antimalarials was not significantly different in these 26 patients as compared to the rest (74 cases). All patients developing ARDS expired. The present study concludes that malarial atypical respiratory presentations are far higher in incidence than reported in literature. Peripheral smear examination in all patients of high grade fever with chills and rigors and having respiratory manifestations may unmask malarial infection and warrant early antimalarial treatment resulting in decreased morbidity and mortality. 相似文献
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