2006—2013年菏泽市输入性恶性疟的临床特点与处置分析

目的探讨2006—2013年25例输入性恶性疟的流行特征及临床诊断和治疗效果。方法回顾性分析恶性疟病例的流行病学资料及临床资料。结果 25例恶性疟病例均有蚊虫叮咬史和有非洲地区居留史,临床症状主要为发热、畏寒、大汗、呕吐、贫血、血小板数减少、和肝肾功能异常等。在蒿甲醚联合伯氨喹治疗后,25例恶性疟均获痊愈,无输入性恶性疟传播。结论菏泽市输入性恶性疟以有非洲旅居史,青年、中年男性为主,近年来发病有所增加;恶性疟诊断主要依靠反复外周血涂片检测;蒿甲醚联合伯氨喹治疗方案治疗效果可靠。     

Current situation of malaria in Japan and its prevention

Cases of malaria have increased steadily in Japan during the past 20 years, and deaths have been reported. Patients with malaria were all infected in regions where the disease is prevalent (imported malaria). A report from the former West Germany noted a high mortality rate (9.3%) among patients with falciparum malaria. According to the report, the pathological manifestation of the disease and its complications are extremely complex. This report discusses malaria in Japan, especially falciparum malaria, with particular emphasis on the above findings.     

广西2010--2012年输入性疟疾流行病学分析

目的 分析2010－2012年广西壮族自治区（广西）输入性疟疾流行病学特点和趋势,为进一步提高疟疾控制后期输入性疟疾监测及诊治能力,保证2018年消除疟疾目标的实现提供科学依据。方法 收集2010－2012年广西全区输入性疟疾病例个案调查表、网络直报病例等监测数据,对输入性疟疾的感染来源、虫种、人群和地区分布,发病及诊治等进行描述和统计学分析。结果 3年来广西共报告国外和区外输入性疟疾病例397例,其中恶性疟261例,间日疟102例,三日疟7例,卵形疟3例,混合感染8例,未分型16例,死亡4例。病例主要分布在南宁、桂林、河池、百色、玉林和崇左6个地级市,占全区输入性疟疾病例数的92.70%（368/397）。男女性别比为55.7∶1,年龄分布集中在20～50岁组,农民和工人占病例总数的85.39%（339/397）。国外输入病例最多的是非洲加纳共212例,其次为缅甸68例,柬埔寨26例。结论 当前广西疟疾发病以国外输入性病例为主,且多数为恶性疟。输入性疟疾疫情严峻,为确保2018年广西消除疟疾目标的实现,应加强对外出非洲和东南亚地区务工返回人员疟疾监测,及时发现和有效治疗输入性传染源。     

武汉市116例境外输入性恶性疟临床治疗效果分析

目的分析和评价境外输入性恶性疟患者临床特点及青蒿素类药物治疗效果,促进合理规范用药,提高临床治愈率。方法收集武汉市省级疟疾定点医院收治的116例输入性恶性疟病例,对患者临床症状及体征、青蒿素药物使用情况及用药效果等进行回顾性分析。结果输入性恶性疟临床表现复杂多样且并发症较多,主要为发热、纳差、贫血、黄疸等;使用青蒿素治疗后症状均减轻或消失,无明显药物不良反应,退热中位数为2d,疟原虫转阴中位数为3d,临床症状缓解中位数为3d;109例普通型恶性疟采用青蒿素复方口服或青蒿琥酯针剂联合青蒿素复方口服治疗,其中30例口服青蒿素复方治疗1~4d, 1例复燃;79例青蒿琥酯针剂联合青蒿素复方口服治疗4~6d, 4例出现复燃。7例重症病例采用青蒿琥酯针剂联合口服多种青蒿素复方长疗程大剂量后均治愈,总治愈率95.69%(111/116)。结论患者以口服和注射青蒿素杀灭疟原虫治疗恶性疟安全有效,治愈率高,但部分患者停用青蒿素类药物后出现疟原虫复燃,为遏制患者重症和抗药风险,应"规范、全程、足量"使用青蒿素类药品。     

国境口岸输入性恶性疟的现状与预防控制

目的了解近年来我国境外输入性恶性疟疫情,探讨现阶段恶性疟预防与控制措施。方法查阅了2006年以来所有详细报道我国国境口岸输入性恶性疟的文献,对有关感染地区、诊疗状况等相关资料进行分析。结果输入性恶性疟最主要的感染地为非洲和东南亚地区,其中非洲地区的尼日利亚、安哥拉、几内亚、赤道几内亚,东南亚的缅甸是我国输入性恶性疟来源最多的国家。恶性疟易引起误诊,感染者常因未得到及时有效的抗疟治疗而死亡。疟疾病人的实验室诊断率有待提高,采用疟原虫抗原快速检测法和PCR法等疟疾诊断新技术作为镜检的补充,有助于提高疟疾诊断水平。赴非洲等恶性疟高发区的归国劳务人员,恶性疟发病率高、复燃比例高,采用以青蒿素类药物为主的联合疗法可提高疗效和阻止疾病传播。结论我国国境口岸输入性恶性疟防治重点是加强境外输入性疟疾监测与管理,提升恶性疟的诊疗水平,提高出国人员疟疾的自我防护能力。     

Risk factors for imported fatal Plasmodium falciparum malaria, France, 1996-2003

Plasmodium falciparum malaria is a serious health hazard for travelers to malaria-endemic areas and is often diagnosed on return to the country of residence. We conducted a retrospective study of imported falciparum malaria among travelers returning to France from malaria-endemic areas from 1996 through 2003. Epidemiologic, clinical, and parasitologic data were collected by a network of 120 laboratories. Factors associated with fatal malaria were identified by logistic regression analysis. During the study period, 21,888 falciparum malaria cases were reported. There were 96 deaths, for a case-fatality rate of 4.4 per 1,000 cases of falciparum malaria. In multivariate analysis, risk factors independently associated with death from imported malaria were older age, European origin, travel to East Africa, and absence of chemoprophylaxis. Fatal imported malaria remains rare and preventable. Pretravel advice and malaria management should take into account these risk factors, particularly for senior travelers.     

2005-2011年青神县输入性疟疾个案调查

目的掌握青神县输入性疟疾流行现状,为制定疟疾防治策略提供科学依据。方法对2005-2011年青神县实验室确诊输入性疟疾病例的个案调查进行分析。结果 2005-2011年共有实验室确诊输入性疟疾病例65例,其中间日疟37例,恶性疟27例,混合感染1例。病例分布于青神8个乡镇,占全县乡镇的80%;除12月外其余各月均有发病;男女性别比为15.25∶1;年龄在17～46岁间;职业全为民工。感染地主要为云南、缅甸等疟疾高发区,病例为62例,占输入病例95.39%。结论青神县输入性疟疾均为外出打工的青壮年,以男性为主,病例感染地主要为云南、缅甸疟疾高发区。     

武汉东西湖区输入性疟疾流行病学及临床特点

目的探讨武汉市东西湖区收治的输入性疟疾流行病学和临床特征。方法对2015年2月至2016年12月武汉市医疗救治中心收治的输入性疟疾患者流行病学资料、临床表现、诊治情况等进行描述性分析。结果共收集37例输入性疟疾,恶性疟35例(94.59%),卵形疟2例(5.41%);除发热外,畏寒占54.05%、寒战48.65%、出汗29.73%、头痛37.84%、恶心呕吐62.16%、腹泻18.92%、肌肉酸痛13.51%;此组患者误诊率54.05%;经青蒿琥酯、双氢青蒿素哌喹及伯喹联合治疗,第4d内体温恢复正常者占90.91%,第6d外周血涂片疟原虫检查转阴者占84.38%,至23d累计32例(86.49%)患者治愈出院,复燃1例(2.70%)。结论输入性疟疾以恶性疟为主,患者临床表现复杂多样,并发症多;必须加强疟疾诊断防治知识教育和镜检技能培训和考核,保持对输入疟疾的发现与诊治能力。青蒿素类药物联合治疗输入性疟疾疗效可靠应予坚持。     

成都地区输入性恶性疟疾临床分析

目的探讨成都地区输入性恶性疟疾的临床特点及其诊断与治疗。方法回顾性分析12例输入性恶性疟疾的临床资料。结果12例输入性恶性疟疾均有蚊虫叮咬史,但其中有1例未到过恶性疟疾高发区。临床表现复杂多样,可出现畏寒、发热、头疼、恶心或呕吐、腹痛、腹泻、黑便、腹水、黄疸、贫血、肾功能衰竭、肝功能损害、黑尿热等表现。使用"双疗程"抗疟治疗,治愈10例,死亡2例。结论恶性疟疾早期临床表现复杂,且合并症繁杂多样,易误诊。临床上遇有在疟区生活、工作、旅游过的人员,一但出现发热,应及时行血涂片或骨髓穿刺检查,以免延误诊治。使用"双疗程"抗疟治疗,可有效减少再燃。此外成都地区存在传播恶性疟疾的按蚊,出现输入性恶性疟疾继发病例甚而流行的危险性不容忽视。     

Tumor necrosis factor-alpha promoter variant 2 (TNF2) is associated with pre-term delivery, infant mortality, and malaria morbidity in western Kenya: Asembo Bay Cohort Project IX.

A polymorphism in the promoter region of the tumor necrosis factor-alpha (TNF-alpha) gene, with a guanine to adenine nucleotide change at position -308, TNF2 is associated with increased TNF-alpha production. TNF2 homozygotes have a higher risk of severe disease and/or death due to cerebral malaria and other infectious diseases. We investigated the impact of this allele on malaria morbidity and mortality in young children who participated in an immuno-epidemiologic cohort study of malaria in an area of intense perennial Plasmodium falciparum transmission in western Kenya. A total of 1,048 children were genotyped. Poisson regression and Cox proportional hazards models were used to determine the relationship between TNF-308 variants and morbidity and mortality. The gene frequencies of the TNF1 and TNF2 alleles were 0.90 and 0.10, respectively. TNF2 homozygosity was associated with pre-term birth when compared with TNF1 homozygotes [relative risk (RR) 7.3, 95% CI, 2.85-18.9, P = 0.002) and heterozygotes (RR 6.7, 95% CI 2.0-23.0, P = 0.008). Among children born prematurely, the TNF2 allele was significantly associated with a higher risk of death in infancy compared with TNF1 (RR 7.47, 95% CI 2.36-23.6). The risk of death was higher among TNF2 homozygotes than among heterozygotes. The TNF2 allele was significantly associated with high density P. falciparum parasitemia (RR 1.11, 95% CI 1.0-1.24). Among low birth weight children, the TNF2 allele was associated with severe anemia (RR 2.16, 95% CI 1.17-4.01) and showed a trend toward a risk for severe malaria anemia (RR 1.99, 95% CI 0.89-4.46). These data suggest that TNF2 is a risk factor for pre-term birth and early childhood mortality and malaria morbidity in children in this region. Further understanding of the pathogenic mechanisms underlying this association is required.     

常州市2006～2010年输入性恶性疟调查分析

目的通过对常州市输入性恶性疟进行个案分析,研究该病的流行趋势。方法对常州市2006～2010年27例输入性恶性疟病例的个案资料进行回顾性调查和分类统计。结果 27例输入性恶性疟病例均为从非洲高疟区回国人员,无明显的发病季节,部分恶性疟病人因未及时就诊而出现重症表现。结论对来往于非洲等高疫区人员加强疟疾监测,从高疟区回归人员发热临床医生应提高首先考虑恶性疟的意识。     

重症恶性疟疾192例临床分析

目的了解恶性疟疾临床特征,早期识别重症患者和降低病死率。方法对2008年8月～2009年8月腾冲县人民医院经过血涂片检查确诊恶性疟疾192例患者的临床症状、诊治情况进行回顾性分析。结果各重症类型表现分别有意识障碍、重度贫血、循环衰竭、黄疸、水肿、心律失常及广泛出血等。192例重症恶性疟疾患者,痊愈185例（96．4％）,留有后遗症2例（1．04％）,死亡5例（3．6％）。结论尽早抗疟治疗,对抗药性及并发症的恰当处理是降低病死率的关键。氯喹有耐药趋势,青蒿琥酯是安全有效的首选药物。     

宜宾市输入性疟疾的流行特征分析

目的 分析2008—2020年宜宾市疟疾流行病学特征,为探讨相应防控策略提供科学依据。方法 描述疟疾疫情概况、感染来源、分布特征、病例管理情况。结果 报告疟疾病例包括间日疟（35.21%）、恶性疟（52.11%）和未分型疟疾（12.68%）。病例主要来源国家是缅甸、刚果、多哥,分别占37.25%、17.65%、9.8%。宜宾县、翠屏区报告病例最多,6—8月和10月报告病例较多,患者主要为青壮年男性农民工。病例3 d内就诊率达100%,按照“1～3～7”管理规范,24 h上报率、3 d内个案流行病学调查率、7 d内疫点处置率均为100%。医疗机构初诊正确率为60.78%。中华按蚊为主要传播媒介,2018、2019、2020年密度分别为0.01、0和0.006只/（灯·h）。结论 宜宾市输入性疟疾有一定地区性和季节性分布规律,且本地存在再发风险,应根据每年输入病例和媒介监测情况动态掌握各县区风险分层,利用人员出入境时间流动规律,做到早筛查、早发现、早诊断、早治疗。     

一次性输入7例恶性疟疾的调查及处理报告

[目的] 根据1999年7月15日收到的韩国籍“皇家”号轮在航行中转发的电报,对其实施医疗救助。[方法] 在组织医疗救护的同时,开展了流行病学调查、个案调查、医学监测、血片镜检疟原虫等工作。[结果] 至1999年7月19日,“皇家”号轮本次共发生5例疟疾现症病人;2例带虫者。全船17名船员血检,发现阳性血片7份,阳性率为41．2％;6名发热船员血检,发现阳性血片5份,阳性率为83．3％。对现症病人和带虫者,为避免抗药性采用蒿甲醚根治疗法;对其它船员作假定性抗疟治疗,全部船员投放足量预防药(备用)。对货物(圆木)用体积分数为0.3％的敌敌畏行快速有效灭蚊,切断传播途径。[结论] 本次调查、处理中,利用因特网等现代技术迅速获取有关流行病学资料,在本次疫情的顺利调查及时诊断方面,显示其重要性;快速有效灭蚊措施的落实,切断了传播途径是本次疫情扑灭的关键。     

四川省疟疾流行态势与消除疟疾进展

目的分析四川省疟疾流行态势与消除疟疾工作进展情况。方法对全省疟疾发病与流行态势进行描述性研究。结果 1950-2012年四川省疟疾发病人数由最高时的58多万下降到近年的100余人,下降达99.98%以上,已连续19年年发病率控制在1/万以下;自2011年及以后全省本地疟疾病例报告均为0,即输入病例占总病例的100%;输入病例散在分布,全年均有发病,无明显季节分布;人群感染以男性为主（男：女=26.5：1）;职业以农民及农民工和工人为多（占72.25%）;年龄集中在青壮年（20-59岁）占95.15%;输入病例中,恶性疟占输入总病例的57.42%,主要输入地为非洲和东南亚。结论四川省疟疾发病大幅度下降,疟防进程已由控制阶段走向消除阶段。在此基础上,应进一步加强疟疾监测和流动人员管理,加快消除疟疾工作。     

湖南省郴州市2003-2012年疟疾流行特征及监测效果研究

目的 了解郴州市疟疾流行特征及监测效果,为疟疾防治和消除提供科学依据.方法 运用描述性流行病学方法对郴州市2003-2012年疟疾流行病学及监测资料进行统计分析.结果 郴州市2003-2012年共报告疟疾病例41例,年平均发病率为0.09/10万,死亡1例,无暴发疫情;其中间日疟24例（58.54％）,恶性疟15例（36.58％）,三日疟2例（4.88％）;本地病例4例（9.76％）,输入性病例37例（90.24％）,93.33％（14/15）的恶性疟病例均由非洲输入;发热患者血检107 975人次,阳性率为3.43/万,疟疾病例实验室检测率和确诊率均为100％;传疟媒介主要以中华按蚊为主（86.04％）,蚊密度高峰出现在7-8月.结论 郴州市基本消除疟疾后,疟疾疫情控制在较低水平,病例以输入性为主,在今后的疟疾防治和消除工作中,应加强流动人口监测和发热患者血检.     

Imported malaria in Kuwait

The number of imported malaria cases in Kuwait rose from 87 in 1980 to 504 in 1983, an increase of 579%. The continued resurgence of malaria in endemic zones, improved diagnostic techniques and a heightened awareness of imported malaria have contributed to the increase in the number of microscopically proved cases. Thick blood films fixed in acetone and stained in Giemsa proved a rapid method of diagnosis; species identification on the basis of a thin film on the same slide was performed with ease. Malaria was acquired in 38 countries. Most patients were young male adults. Most of the cases were due to Plasmodium vivax originating from India, although an increasing number of P. falciparum cases are also now being diagnosed from there. P. falciparum infections were evenly distributed throughout the year and most cases presented within 14 days of their arrival in the country. The highest number of P. vivax cases were diagnosed between May and October, when heat stress might have been a factor in precipitating a clinical attack of an infection previously acquired in the endemic zone. Attention is drawn to the importance of delayed attacks of P. vivax and, in semi-immunes, of P. falciparum. The time interval involved in establishing a history of "recent" travel in clinically suspected cases of malaria needs to be more clearly defined in each geographical area. Cases of induced malaria due to transfusion, accidental and congenital infections were identified. The fatality rate due to P. falciparum infections was low. In terms of the risk of renewed transmission, Kuwait may be considered a vulnerable area.     

1950—2020年安徽省太湖县疟疾流行情况分析

目的 分析太湖县疟疾流行情况,总结流行趋势及特点,探讨下一步疟疾防控工作重点。方法 利用传染病监测报告信息系统等收集整理太湖县1950—2020年疟疾疫情数据等资料,描述性分析太湖县疟疾流行情况。结果 1950—2020年70年间太湖县共发生疟疾162 542例,死亡54例。2011年发现最后一例本地感染病例(间日疟)。2012—2020年共报告6例境外输入病例,包括5例输入性恶性疟,1例输入性卵形疟。结论 现阶段太湖县疟疾的发病模式已由本地感染间日疟转变为境外输入性恶性疟为主,今后应加强对输入性疟疾防控。     

Imported severe malaria in adults: a retrospective study of ten cases admitted to intensive care units in Casablanca

INTRODUCTION: We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital. MATERIAL AND METHODS: All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated. RESULTS: Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died. CONCLUSION: The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.