1例以腹泻为首发症状的输入性恶性疟感染病例报道

探讨一例以腹泻为首发症状的输入性疟疾病例的临床特征和流行病学资料,为输入性疟疾诊治及预防提供参考资料。收集该病例实验室检测结果、临床诊治经历及流行病学等资料并进行分析。该患者疟疾发作以腹泻为首发症状,血细胞分析：白细胞计数（WBC）5.02×10⁹/L,红细胞计数（RBC）3.91×10¹²/L,血红蛋白（HGB）130 g/L,血小板计数（PLT）81×10⁹/L,中性粒细胞比例（NEU%）85.1%,嗜酸性粒细胞比例（EOS%） 1.3%。C-反应蛋白（CRP）53.29 mg/L,血浆D 二聚体 4.93 μg/mL。疟原虫快速诊断试剂（RDT）检测提示恶性疟原虫,显微镜检出疟原虫环状体。立即行双氢青蒿素哌喹片口服药物治疗,2 d后症状缓解,患者血样经PCR 分型鉴定为恶性疟原虫。我国输入性疟疾报道时有发生,出入境检验检疫部门应加强疟疾防治健康教育和疟疾病人排查力度,临床医生在接诊患者时应提高出国史问诊意识,防止这种以腹泻等不典型为首发症状的疟疾漏检和误诊。

A case report of imported falciparum malaria infection with diarrhea as the first symptom

To discuss the clinical characteristics and epidemiological data of an imported malaria case with diarrhea as the first symptom, so as to provide reference for the diagnosis, treatment and prevention of imported malaria.The data of laboratory test results,clinical diagnosis and treatment experience and epidemiology, were collected and analyzed. Diarrhea was the first symptom of malaria in this patient. Blood cell analysis: White blood cell count (WBC) 5.02×10⁹ /L, red blood cell count (RBC) 3.91×10¹² /L, hemoglobin (HGB) 130 g/L, platelet count (PLT) 81×10⁹ /L, neutrophils (NEU%) 85.1%, the proportion of eosinophils (EOS%) 1.3%, C-reactive protein (CRP) 53.29 mg/L, the plasma D dimer 4.93 μg/mL, the parasite rapid diagnostic reagent (RDT) prompted Plasmodium falciparum, microscopic examination of the parasites showed annular body. Dihydroartemisinin-piperaquine tablets were administered orally immediately, and the symptoms were relieved 2 days later. The blood samples of the patients were identified by PCR typing as Plasmodium falciparum. Imported malaria has been reported from time to time in China, and entry-exit inspection and quarantine departments should strengthen health education of malaria prevention and treatment and the screening of malaria patients, and clinicians should enhance the awareness of national history diagnosis when receiving patients, so as to prevent the missed detection and misdiagnosis of malaria with diarrhea and other atypical symptoms as the first symptoms.