输入性疟疾流行病学特征及临床表现与诊治情况分析

Epidemiological characteristics,clinical manifestations,diagnosis and treatment status of imported malaria

目的分析输入性疟疾流行病学特征和临床表现以及诊治中存在问题。方法收集2003年3月-2010年12月在湖南省疾病预防控制中心寄生虫病实验室确诊的疟疾病例,并收集患者曾在外院门诊或住院病历和实验室检查的相关资料;对确诊的疟疾病例采用描述性流行病学方法进行回顾性分析和给予规范治疗。结果 66例输入性疟疾病人,其中男性57例,女性9例。年龄6~58岁,平均年龄34.9岁。农民占68.2%,工程技术人员、学生、商贸等职业占31.8%。间日疟占71.2%,恶性疟占24.2%,恶性疟、间日疟混合感染占4.6%。外省输入性病例占39.7%,非洲和东南亚国家输入性病例60.3%。本省居民占86.4%,外省居民占12.1%,外国居民占1.5%。本省居民外省感染16例(24.2%),本省居民国外感染42例(63.6%),外省居民外省感染7例(10.6%),外国居民国外感染1例(1.5%)。发病距确诊时间最短者为3d,最长者240 d,平均22.3 d。曾在外院被误诊为上呼吸道感染、伤寒、败血症感冒等20种疾病。结论输入性疟疾误诊、漏诊较为普遍,应加强临床医生对疟疾诊断、治疗和疟原虫镜检技术的培训,提高诊治水平。

Objective To analyze the epidemiological characteristics and clinical manifestations of imported malaria in Hunan Province, and to investigate the existing problems in its diagnosis and treatment. Methods The malaria cases confirmed in La- boratory of Parasitic Diseases in Hunan Provincial Center for Disease Control and Prevention from March, 2003 to December, 2010 were recruited, and the cases＇ outpatient or inpatient records and laboratory examination results in other hospitals were collected. The cases were retrospectively analyzed by descriptive epidemiological methods and given standardized treatment. Results There were 66 cases of imported malaria, including 57 males and 9 females. Their age ranged from 6 to 58 years old, with the aver- age age of 34.9 years. Farmers accounted for 68.2%, and engineering and technical personnel, students, business and other occu- pations accounted for 31.8%. The cases of vivax malaria, falciparum malaria and mixed malaria infections accounted for 71.2%,24.2% and 4.6% respectively. The imported cases from other provinces accounted for 39.7%, and those from Africa and Southeast Asian countries accounted for 60.3%. The resident cases of Hunan Province and other provinces accounted for 86.4% and 12.1% respectively, while foreign cases accounted for 1.5%. 16 （24.2%） local cases got infected in other provinces, 42 （63.6%） local cases got infected in other countries, 7 （10.6%） residents of other provinces got infected in other provinces and 1（1.5%） foreign case got infected in other countries. Tile shortest time from onset to diagnosis was 3 days, while the longest 240 days, with an aver- age of 22.3 days. 20 kinds of diseases, such as upper respiratory tract infection, typhoid fever, sepsis and cold, got involved into misdiagnoses. Conclusions Misdiagnoses and missed diagnoses of imported malaria cases in Hunan Province are common. It is necessary to enhance the training about diagnosis and treatment of malaria and microscopy of Plasmodium among the clinicians and improve their diagnosis and treatment level.