6例不同时段发病的混合感染疟疾病例分析

Mixed infection of malaria:report of 6 cases with attack at different incubation

目的对6例不同时段发病的境外输入性混合感染疟疾病例进行调查分析,为输入性疟疾防控提供参考。方法收集该6例病例回国后各次发病的网报和专报信息、流调报告,以及基层医疗机构的临床病例资料和省级疟疾诊断参比实验室镜检、PCR复核结果。结果6例疟疾病例,均有境外生活史,在境外居住时间最短为10 d,最长为1229 d;回国后至第二次发病均无再出国史。6例疟疾病例从回国至第一次发病间隔1~10 d,第一次发病均被确诊为恶性疟原虫感染,接受抗疟治疗后均痊愈出院。从第一次发病痊愈出院至再次发病间隔时间为22~133 d,第二次发病3例为三日疟原虫感染、3例为卵形疟原虫感染。两次发病感染疟原虫虫种均经江苏省疟疾诊断参比实验室镜检和PCR复核并确认。对6例病例第二次发病痊愈后随访1年以上,健康状况良好。结论6例疟疾病例是不同时段发病的境外输入病例,为恶性疟与卵形疟或三日疟混合感染,今后应加强该类病例的防控,巩固消除疟疾成果。

Objective To investigate and analyze the mixed infection of malaria in 6 imported cases with different incubation period for evidence to plan prevention and control measures for imported malaria.Methods Information of the 6 imported cases was collected from the case registration and management system of malaria besides clinical case data from primary medical institutions,microscopic examination and recheck findings by PCR performed in provincial reference laboratory.Results All of the 6 malaria cases had a history of living abroad,and the shortest time of living abroad was 10 days and the longest 1229 days.After returning to China,they never went abroad again.The first onset for the 6 cases ranged from 1 to 10 days after their return,initially diagnosed as Plasmodium falciparum infection,and discharged following antimalarial medication.The interval was 22~133 days between discharge from hospital and the second attack.Three of the six cases were diagnosed as coinfection with P.falciparum and P.malariae,and another three as coinfection with P.falciparum and P.ovale.The infected plasmodium species in twice attacks in the 6 cases were subjected to microscopic examination and PCR recheck performed in the provincial reference laboratory.All patients were followed for over one year after discharge from the second attack,and well recovered.Conclusion The 6 cases of imported malaria with different incubation period are associated with P.falciparum and P.ovale infection or mixed P.malariae infection.The findings suggest that prevention and control of such cases should be strengthened in the future in order to consolidate efforts in elimination of malaria.