外周血出现裂殖体非重症恶性疟1例分析

A case of uncomplicated P. falciparum with mature trophozoites in peripheral blood

2020年1月腾冲市报告的1例非洲输入性恶性疟病例,曾到刚果金务工,自述在国外期间曾患疟疾,于回国途中发病。实验室检查白细胞3.89×10~9/L,血红蛋白141 g/L,血小板75×10~9/L,丙氨酸转氨酶188 U/L,天门冬氨酸转氨酶110 U/L,总胆红素29.3μmol/L,血糖6.66 mmol/L,尿素氮3.8 mmol/L,肌酐95μmol/L。其血涂片显微镜下可见环状体、大滋养体、未成熟裂殖体,疟原虫密度54846个/μL血,环状体占86.38%(8640/10002)、大滋养体占13.51%(1351/10002)、裂殖体占0.11%(11/10002),PCR基因检测确诊为恶性疟,经抗疟及对症支持治疗后痊愈。恶性疟外周血中出现裂殖体期原虫较少见,镜检时应注意与其他疟原虫鉴别。

Tengchong county reported a case of import P.falciparum infected from African in January,2020.He once went to work in the Democratic Republic of Congo,and he reported that he had contracted malaria during his stay abroad and became ill on the way home.Laboratory examination showed that WBC 3.89×10~9/L,HGB 141 g/L,PLT 75×10~9/L,ALT 188 U/L,AST 110 U/L,TBIL 29.3μmol/L,GLU 6.66 mmol/L,BUN 3.8 mmol/L,CR 95μmol/L.Peripheral blood smear confirmed ring-stage trophozoites,mature trophozoites and immature schizonts by microscopy.The parasite density was 54846 asexual parasites/μL.The percent of ring-stage trophozoites,mature trophozoites and immatured schizonts were 86.38%(8640/10002),13.51%(1351/10002)and 0.11%(11/10002)respectively.Further confirmation was conducted as P.falciparum by nested polymerase chain reaction(PCR)assay.The patient was fully recovered after antimalarial and supportive treatments.The presence of schizonts for P.falciparum in peripheral blood is rare,we should be careful to identify under microscopy detection.