危重症疟疾25例误诊分析

Malaria misdiagnosed:an analysis of critical cases

目的探讨危重症疟疾误诊相关因素。方法对北京地坛医院2000—2010年25例危重症疟疾患者临床资料进行回顾性分析。结果 25例患者均来自北京以外的疟疾流行区,病死率为8%。其中36%的患者首诊以肝功能异常入院,20%以上呼吸道感染为首诊。首次血涂片阳性率为60%。治疗以青蒿素为基础的联合化疗。结论对发热患者应注意流行病学史的询问。危重症疟疾易误诊为其他疾病。考虑疟疾应反复涂片检查。危重症疟疾早诊断、早治疗,以青蒿素为基础的联合化疗,可以降低病死率。

Objective To explore the factors related to misdiagnosis of critical malaria. Methods From 2000 to 2010,the clinical data of 25 patients with critical malaria in Beijing Ditan Hospital were retrospectively analyzed. Results All of these 25 patients came from malaria-endemic areas outside Beijing, among whom the mortality rate was 8%. Notably,36% of the patients were hospitalized due to abnormal liver function and more than 20% due to respiratory infections by primary impression. The positive rate of initial blood smear was 60%. The patients were given Artemisinin-based combination chemotherapy. Conclusion Febrile patients should be investigated for epidemiological history because critical malaria could be easily misdiagnosed. Repeated blood smears are advisable if malaria is suspected. Early diagnosis, early treatment and artemisinin-based combination chemotherapy may contribute to lower mortality rate in patients with critical malaria.