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。

A deathcase of imported falciparum malaria in Hebei

Objective This article reports on 1 death by falciparum malaria in Hebei Province in 2017, so as to prevent the recurrence of falciparum malaria deaths. Methods The information of diagnosis and treatment of the falciparum malaria case from hospitals were collected and analyzed. Results Early symptoms developed after the patient who had worked in Angola for 100 days returned from Africa. The patient had not been diagnosed of malaria. On the 4th day after onset, the patient went to a community health service center for symptomatic treatment. The case had no improvement．Then the patient went to a Dingzhou City Hospital, but the specific genetic cause was unknown. The patient was regulated from the Hebei Chest Hospital to the Second Hospital of Hebei Medical University afterwards. Until the 5th day, the disease was diagnosed in the Fifth Hospital of Shijiazhuang. There were 5 medical institutions from seeing a doctor to being diagnosed. The patient's condition quickly worsened and continued to deteriorate. Seven days after onset and three days after diagnosis, the patient died of cerebral malaria and multiple organ failure despite emergency rescue efforts. Conclusions Poor awareness in seeking health care services and scarce capability on correct diagnosis may be the main causes of death in malaria cases. Health education of malaria prevention, consciousness of active treatment, diagnosis and treatment training of malaria should be strengthened in order to improve the public awareness and the diagnosis ability of clinical doctors for malaria, especially the treatment of severe cases.