陕西省97例输入性疟疾的临床特点及抗疟药物用药分析

Clinical characteristics of 97 cases of imported malaria and analysis of antimalarial drug use in Shaanxi

目的分析陕西省2018年1月—2020年9月收治的97例输入性疟疾的流行病学和临床特征,总结抗疟治疗及转归情况,为提高早期诊断、减少误诊、提高治疗效果提供经验依据。方法回顾分析2018年1月—2020年9月陕西省传染病院收治的疟疾患者住院病例资料,对所有纳入患者的一般资料、流行病学特征、临床特征、治疗方法及疾病转归进行描述性分析。结果 2018年1月—2020年9月,陕西省传染病院收治的输入性疟疾患者97例,其中93例为外出务工的中国籍工人,4例为非洲来西安工作或留学外籍人员;92例来自非洲,5例来自亚洲。恶性疟疾78例,间日疟15例,卵型疟4例,其中重型疟疾占11例(均为恶性疟原虫感染);疟疾全年散发,临床表现主要为发热、畏寒、寒战、头痛、头晕、肌肉酸痛、食欲下降、恶心、呕吐、腹痛等症状。重型疟疾可发生严重肾功能异常或继发嗜血综合征;不同类型疟原虫感染采用针对性的治疗方案,19例间日疟及卵型疟中,12例予口服磷酸氯喹加磷酸伯氨喹治疗,7例予以蒿甲醚注射液治疗。78例恶性疟中,42例口服青蒿素类复方制剂,25例予蒿甲醚注射液治疗,11例重型疟疾有3例在使用青蒿琥酯注射液或蒿甲醚注射液后再口服青蒿素类复方制剂序贯治疗,所有患者疟原虫均转阴,但仍有1例间日疟复发,3例恶性疟原虫再燃,对复发及再燃的病例予再次治疗后亦均治愈。结论对有疟疾流行区居留史的发热患者,及时进行外周血涂片查找疟原虫有助早诊断。对确诊病例宜早采用合理、规范、足疗程抗疟药物,是有效治疗的关键。

Objective To analyze the epidemiological and clinical characteristics of 97 cases of imported malaria in Shaanxi Province from January 2018 to September 2020,and we summarize the anti-malarial treatment and outcome,so as to provide theoretical basis for improving early diagnosis,reducing misdiagnosis and improving treatment effect.Methods Retrospective analysis was conducted on the data of malaria patients admitted to Shaanxi Provincial Infectious Diseases Hospital from January 2018 to September 2020,the general data,epidemiological characteristics,clinical characteristics,treatment methods and disease outcomes of all patients were analyzed.ResultsFrom January 2018 to September 2020,97imported malaria patients were admitted to Shaanxi Infectious Diseases Hospital,among which 93 were young and middle-aged migrant workers,and 4 were African students;92 cases were from Africa,and 5 were from Asia.There were 78 cases of falciparum malaria,15 cases of vivax malaria,and 4 cases of ovalum malaria,of which 11 cases were severe malaria (all were P.falciparum infection).The clinical manifestations of malaria were fever,chills,shiver,headache,dizziness,muscle aches,loss of appetite,nausea,vomiting,abdominal pain and other symptoms.Severe renal dysfunction or secondary hemophilic syndrome may occur in severe malaria.Among the 19 cases of vivax and ovale malaria,12 cases were treated with oral chloroquine phosphate plus primequine phosphate,and 7 cases were treated with artemether injection.Of 78 cases of falciparum malaria,42 cases were treated with oral artemisinin-based combination,25 cases with artemether injection treatment,3 cases of 11severe malaria cases with artesunate injection or artemether injection after oral artemisinin-based combination sequential therapy,all patients achieved good curative effect,plasmodium were all turn negative,but 1 case still had recurrence of vivax,3cases recurrence of falciparum,cases of recurrence also were cured after treatment.Conclusion For febrile patients who have lived in malaria-endemic areas,timely peripheral blood smear to find plasmodium is helpful to make a definite diagnosis as soon as possible,and the use of reasonable,standard and full course of antimalarial drugs as early as possible is the basis and key to the successful rescue of the disease.