厦门地区境外输入性疟疾临床分析

Clinical Analysis of Imported Malaria Cases in Xiamen

目的：探讨厦门地区境外输入性疟疾的流行病学和临床特征。方法对2008年1月～2015年12月，厦门大学附属第一医院感染性疾病科收治的发病前1个月有境外旅居史的确诊疟疾患者28例，进行流行病学和临床特征分析。结果28例患者均为男性，平均年龄（35.1±10.0）岁（年龄20～55岁），发病前1个月有非洲旅居史25例（89.3%）；东南亚旅居史3例（10.7%），均为间日疟。发病到确定诊断中位时间9（3，18）d，发热峰值（40.1±0.6）℃，诊断为恶性疟20例（71.4%），间日疟3例（10.7%），未分型5例（17.9%）。出现低白蛋白血症25例（89.3%）、脾肿大24例（85.7%）、血小板减少21例（75.0%）、贫血18例（64.3%）、肝功能异常15例（53.6%）、肾功能异常4例（14.3%）、出现意识障碍2例（7.1%）。3例间日疟经氯喹＋伯氨喹治愈；20例恶性疟及5例未分型均经青蒿素及其衍生物治愈，用药到热退平均时间（21.0±13.5）h（时间4～50 h）。结论本组厦门地区境外输入性疟疾以有非洲旅居史、恶性疟、男性中青年患者为主；高热、低白蛋白血症、脾肿大、血小板减少、贫血及肝功能异常可作为临床特征提示疟疾的存在；据疟疾分型，给予针对性抗疟及综合治疗效果可靠。

Objective To investigate the epidemiological and clinical features of imported malaria cases in xiamen area.Methods Confirmed malaria inpatient cases from department of infectious diseases in first affiliated hospital of xiamen university were surveyed from January 2008 to December 2015. Twenty-eight cases with overseas travel history within one month before ilness were finaly enroled. Epidemiological and clinical features were investigated. Results Al the 28 cases were male,averageage was（35.1±10.0）y（20-55 y）. Of the 28 cases,25（89.3%）had residence history in africa, 3 cases（10.7%）in south-east asia,were vivax malaria. The median duration between onset and diagnosis was 9（3,18）d. The peak of fever was （40.1±0.6）℃. There were 20 falciparum malaria cases（71.4%）,3 vivax malaria cases（10.7%）and 5 unidentified cases（17.9%）. There were 25 cases（89.3%）having hypoalbuminemia,24 cases（85.7%）having splenomegaly,21 cases（75%）having thrombocytopenia,18 cases（64.3%） having anemia,15 cases（53.6%）having abnormal liver function,4 cases（14.3%）having abnormal kidney functions and 2 cases（7.1%）showing disturbance of consciousness. 3 vivax malaria cases were cured by chloroquine and primaquine,20 falciparum malaria cases and 5 unidentified cases were cured by artemisinin. The duration between beginning therapy and normothermia was（21.0±13.5）h（4-50 h）.Conclusion Most imported malaria cases had Africa travel history. Most of them were falciparum malaria,young and middle-aged male patients. Hyperpyrexia,hypoalbuminemia, splenomegaly,thrombocytopenia,anemia and abnormal liver function might be the indicators of malaria infection. According to the type of malaria, antimalarial and comprehensivetherapy was efficacious.