泸州市18例输入性疟疾临床分析

Clinical analysis of 18 cases of imported malaria in Luzhou

目的:分析泸州市输入性疟疾的流行病学和临床特征,探讨治疗方法。方法:对2012年7月至2014年6月收治住院的18例输入性疟疾患者的临床资料进行回顾性分析。结果:18例患者均为非洲劳务回国人员,男性居多,年龄为(41.1±6.5)岁,8例在国外曾感染疟疾。其中,恶性疟11例、间日疟1例、疟原虫未分型6例,77.8%为重症疟疾。所有病例均发热,9例有寒战、发热、出汗的典型发作,多伴头痛、肌肉酸痛、乏力及恶心,意识障碍3例,贫血7例,脾大5例,双下肢水肿1例,胸腔积液2例。实验室检查以中性粒细胞比值升高,血红蛋白及血小板数下降,肝肾功能异常多见。大部分病例采用蒿甲醚联合氯/伯喹八日疗法,经抗疟及对症治疗后所有病例短期内均临床治愈出院,无死亡病例。结论:输入性疟疾患者临床表现复杂,重症比例高,对发热患者,结合流行病学史和临床表现,及时诊断,早期规范抗疟治疗效果好。

Objective： To analyse the epidemiological characteristics and clinical manifestations of the imported malaria in Luzhou, and to explore the best treatment strategy. Methods： Clinical data of 18 imported malaria cases from July 2012 to June 2014 were collected and analyzed retrospectively. Results： All patients were migrant workers returned from Africa, most were male whose average age was （41.1 ±6.5） years old, 8 patients had past history of malaria in endemic areas.11 patients were infected with plasmodium falciparnm and 1 patient was with plasmodium vivax , other patients were with undifferentiated type, 77.8% were considered severe malaria. All the patients had fever, 50% of the patients had a typical attack containing shiver, fever, and sweating after fever subsided. In addition to fever, headache, muscle soreness, fatigue, and nausea were found in the majority of patients. 3 patients had disturbance of consciousness, 7 patients had anemia, 5 cases had enlarged spleen, 1 case had lower extremity edema, and 2 cases had pleural effusion. Laboratory testing showed that neutrophil ratio were increased,while hemoglobin and platelet count were decreased,and liver and kidney were dysfunctional in most cases. The most patients were cured by artemether combined with chloride/primaquine. After antimalarial and symptomatic treatment, all the cases were cured clinically in a short term and nobody died. Conclusion： The patients with imported malaria have complicated clinical manifestations, with a high proportion of severe cases. Patients coming with fever, epidemiological history, and clinical manifestations should be diagnosed malaria. Early specific antimalarial treatments are recommmended.