62例输入性疟疾病原学特点分析

目的分析境外输入性疟疾疟原虫病原学特点。方法对62例北京友谊医院北京热带医学研究所2015年1—12月所确诊的输入性疟疾患者进行疟原虫虫种及感染阶段鉴定,计算红细胞感染率,并分析45例恶性疟患者红细胞感染率与血小板计数的关系。结果 62例患者通过血涂片确诊,恶性疟45例(72.5%),间日疟8例(12.9%),三日疟4例(6.5%),卵形疟5例(8.1%);50例(80.7%)可见环状体,8例(12.9%)可见大滋养体,2例(3.2%)可见裂殖体,2例(3.2%)可见配子体;31例红细胞感染率<2%,8例≥5%。恶性疟患者红细胞感染率越高,血小板计数越低。结论境外输入性疟疾病原学表现复杂,以恶性疟为主。感染疟原虫的定性与定量测定对于临床诊治均具有重要意义。     

恶性疟疾误诊一例

患者男 ,2 5岁 ,因畏寒、发热伴反复腹泻、黑便 2月余入院。 2个多月前 ,患者饮酒后感全身不适 ,畏寒、轻微寒战 ,体温达 40°Ｃ ,伴剧烈头痛 ,持续 5ｈ后体温恢复正常。曾以青霉素等治疗 3ｄ无效 ,每日发作 1～ 2次 ,疑为“伤寒” ,用阿米卡星等治疗 3ｄ。期间出现腹泻、黑便 ,3～ 4次/日 ,仍有不规则发热 ;曾出现 2次短暂意识丧失 ,经对症处理后清醒 ,病情好转出院。 1个多月前又出现畏寒、发热 ,疑诊“伤寒复发” ,多次血液及骨髓培养均未发现细菌生长。患者曾在越南及缅甸山区经商 3个月 ,常被蚊子叮咬 ,回国前曾有头痛、全身不适约 1周…     

佛山7例输入性疟疾临床分析

目的观察输入性疟疾患者的临床表现和探讨治疗方法。方法联合应用氯喹和伯氨喹治疗间日疟疟疾患者,应用蒿甲醚治疗恶性疟疟疾患者。结果间日疟疟疾对氯喹仍敏感,恶性疟疟疾用氯喹治疗后短期内均复发。结论对于输入性恶性疟疟疾患者,应考虑出现耐氯喹病例,尽早应用蒿甲醚进行治疗。     

输入性恶性疟疾1例救治体会

<正>恶性疟疾在我国现在比较少见,但高发于非洲热带地区,由恶性疟原虫感染所致,常以畏寒、发热、头痛为首发症状,并发症多,若不及时治疗,可危及生命,非洲每年有百万儿童死于疟疾。非疟区的无免疫力人群进入疟区,常为易感者,可引起疟疾暴发流行。当前,非洲埃博拉出血热暴发流行,加强发热患者预检分诊及鉴别诊断尤为重要。1病例资料患者陈某,男,28岁,因2天前无明显诱因出现发热,体温39.4℃,无畏寒、寒战,无高热抽搐。觉双脚乏     

Automated detection of malaria pigment: feasibility for malaria diagnosing in an area with seasonal malaria in northern Namibia

OBJECTIVE: To evaluate the feasibility of automated malaria detection with the Cell-Dyn 3700 (Abbott Diagnostics, Santa Clara, CA, USA) haematology analyser for diagnosing malaria in northern Namibia. METHODS: From April to June 2003, all patients with a positive blood smear result and a subset of patients with no suspicion of malaria were included. Blood smear and a venous blood sample (to determine haemoglobin, platelet and malaria pigment levels) were collected from each patient. Malaria pigment test characteristics, correlations with blood parameters and pigment clearance time were calculated. Finally, a subset of blood samples was run twice to evaluate the consistency of test outcome. RESULTS: Two hundred and eight patients were included. Ninety had a positive blood smear result of which 84 tested positive for malaria pigment and 118 patients had a negative blood smear result of which four tested positive for malaria pigment. Test characteristics as compared with microscopy were as follows: sensitivity 0.93, specificity 0.97, positive predictive value 0.95, negative predictive value 0.95. Rerun of the blood samples resulted in a change of diagnosis in 14%. After 4 weeks, 33% of patients with an initially positive pigment result still tested positive. Malaria pigment was found to be negatively correlated with haemoglobin. CONCLUSIONS: Automated detection of malaria pigment is a useful diagnostic tool in this semi-rural area. In low-risk malaria season, the test can be used for diagnosing malaria because of the high sensitivity. In high-risk malaria season, the test can be used for excluding malaria in case of a negative pigment result because of the high specificity.     

Use of clinical algorithms for diagnosing malaria

Several attempts have been made to identify symptoms and signs based algorithms for diagnosing malaria. In this paper, we review the results of published studies and assess the risks and benefits of this approach in different epidemiological settings. Although in areas with a low prevalence the risk of failure to treat malaria resulting from the use of algorithms was low, the reduction in the wastage of drugs was trivial. The odds of wastage of drugs increased by 1.49 (95% confidence limit 1.45-1.51) for each 10% decrease in the prevalence of malaria. In highly endemic areas the algorithms had a high risk of failure to treat malaria. The odds of failure to treat increased by 1.57 (95% confidence limit 1.50-1.65) for each 10% increase in the prevalence. Furthermore, the best clinical algorithms for diagnosing malaria were site-specific. We conclude that the accuracy of clinical algorithms for diagnosing malaria is not sufficient to determine whether antimalarial drugs should be given to children presenting with febrile illness. In highly endemic areas where laboratory support is not available, the policy of offering antimalarial drugs to all children presenting with a febrile illness recommended by the integrated child management initiative is appropriate.     

Rapid diagnostic testing for malaria

Malaria rapid diagnostic devices (MRDD) have been developed with the hope that they would offer accurate, reliable, rapid, cheap and easily available alternatives to traditional methods of malaria diagnosis. The results from early malaria rapid diagnostic studies were quite promising, especially for detecting Plasmodium falciparum at densities of more than 100-500 parasites/microl. Despite the introduction of these devices over a decade ago, only a few target antigens have been introduced. Of greater concern, these devices have shown limitations in sensitivity, ability to differentiate species and robustness under field conditions in the tropics. Recent trials have revealed wide variability in sensitivity both within and between products. We review the recent trials assessing MRDD use for the diagnosis of P. falciparum and non-P. falciparum infections in endemic and non-endemic countries and describe the various aspects of these devices which need further improvement. High quality, accurate, rapid and affordable diagnostic tools are urgently needed now that new antimalarial regimens, characterized by higher cost and increased toxicity, have been introduced more widely in response to emerging multi-drug resistance.     

驻西非3例华人特殊疟疾病例诊疗体会

疟疾是对全球健康影响最大的传染病,西非是疟疾的高流行地区。本文通过报道我国援塞拉利昂军事医学专家组在塞拉利昂诊治的3例疟疾患者的经验和体会,以期为临床医生在诊治类似疾病时提供参考、借鉴。     

Diagnosis of malaria aided by polymerase chain reaction in two cases with low-level parasitaemia

Abstract
Light microscopy of thick and thin blood smears is the mainstay of malaria diagnosis. In situations of low-level parasitaemia such as drug-modified disease, however, this may be difficult making clinical management problematic. Polymerase chain reaction (PCR) methods have shown high sensitivity for the diagnosis of malaria and are able to differentiate the Plasmodium species involved. Two cases are presented in the present study, which illustrate how a PCR method can aid light microscopic malaria diagnosis and species differentiation in returned travellers with low-level parasitaemia. Plasmodium vivax was detected by PCR prior to the light microscopy becoming positive in one case, and in the second case Plasmodium malariae was detected when light micro­s­copy was unable to speciate the causative Plasmodium species. (Intern Med J 2003; 33: 613−615)     

138例输入性恶性疟治疗效果观察

目的 目的 总结输入性恶性疟临床特点及治疗方法, 为其诊断和治疗提供科学依据。方法 方法 对2007年1月-2013 年2月山东省寄生虫病防治所收治的138例输入性恶性疟病例的临床资料进行分析。结果 结果 138例病人全部来自非洲 国家, 临床表现以发热、 头痛、 乏力、 肝脾肿大为主, 实验室检查多有红细胞、 血小板计数降低, 乳酸脱氢酶水平升高。有 36.96%的病例被误诊为呼吸系统疾病、 肾炎、 肝炎等。采用蒿甲醚、 伯氨喹、 青蒿琥酯、 双氢青蒿素、 双氢青蒿哌喹片等抗 疟药治疗及对症治疗后, 近期治愈率为98.55%, 远期治愈率为94.93%, 未愈1例, 死亡1例。结论 结论 青蒿素类仍是最有效 的抗恶性疟药物, 但部分病例因体内疟原虫对该药存在抗药性或敏感性下降而复燃。应重视重症疟疾的早期抗疟及对 症治疗, 以提高治愈率、 降低死亡率。     

Post-transfusion malaria in thalassaemia patients

Summary A total of 125 -thalassaemia patients receiving repeated blood transfusions were screened by Giemsa stain, Acridine-orange stain and antigen detection for evidence of malaria infection on each visit. A total of 8 (6.4%) of the patients developed post-transfusion malaria (PMT) as confirmed by tracing the infected blood donors. A high incidence of PTM in thalassaemia patients appears to be due to the use of fresh blood and the high frequency of blood transfusions required by these patients. Antigen detection using monoclonal antibody was found to be more sensitive for diagnosis of PTM and for screening suspected donors than the conventional blood smear examination methods and is therefore recommended for routine blood donor screening to rule out malaria infection.     

The molecular epidemiology of malaria

This review discusses how the use of molecular genetic techniques such as the polymerase chain reaction are helping in the management and prevention of malaria.     

肾结核155例诊治分析

目的 探讨肾结核的临床表现、诊断和治疗,以提高早期诊治水平. 方法 回顾性分析我院2003年7月—2014年4月收治的155例肾结核患者的临床资料.结果 肾结核高发年龄段是40~60岁(47.1%).将患者分为2组,具有3种或以上临床常见症状者为典型肾结核组(典型组),有患者94例;其余为不典型肾结核组(不典型组),有患者61例.临床最常见的症状依次为尿急(62.6%)、尿频(60.0%)、腰痛(54.3%)、尿痛(51.6%)和血尿(44.5%),腰痛是不典型肾结核组最常见的症状(49.2%).132例患者行尿沉渣找抗酸杆菌检查,阳性率为31.8%.超声检查结果异常率为84.5%,诊断符合率为38.1%.CT检查结果异常率为95.1%,诊断符合率为79.9%. 123例患者行手术治疗,其余32例患者接受抗结核药物治疗. 结论 肾结核的诊断主要依靠临床症状、 实验室检查和影像学检查,CT对明确诊断有重要意义. 肾结核早期诊断困难且需要综合分析判断. 手术是中晚期肾结核的重要治疗手段.