1例来自孟加拉国的青蒿素耐药恶性疟病例分析

A case report of artemisinin-resistant falciparum malaria from Bangladesh

收集并分析了联合国驻刚果(金)稳定特派团中国二级医院于2021年2月20日收治的1例来自孟加拉国的青蒿素耐药恶性疟病例的临床资料和实验室检查,讨论了青蒿素耐药目前的现状及相关治疗,为救治青蒿素耐药恶性疟提供思路。该患者主因“高热伴腹痛,呕吐3 d”入院。自诉曾3次得过“疟疾”并痊愈。入院前曾在乌维拉一级医院接受过蒿甲醚治疗(具体不详)。查血涂片及疟疾快速诊断试验诊断为恶性疟,血中疟原虫密度计数43008/μL。血小板数40×10^(9)/L,谷丙转氨酶174 U/L,谷草转氨酶292 U/L,总胆红素38.2μmol/L。予以青蒿琥酯注射治疗2 d后,患者仍有发热,但呕吐症状减轻。2月23日使用口服复方双氢青蒿素片治疗,效果不佳,考虑青蒿素耐药可能。2月25日开始使用奎宁联合多西环素的7 d治疗,随后患者体温恢复正常。复查血中疟原虫清除,肝肾功能正常,患者于3月4日办理出院。28 d随访无复发。

This article collects and analyzes the clinical data and laboratory examination of one case from Bangladesh with artemisinin resistance of plasmodium falciparum in China secondary hospital stationed in Democratic Republic of the Congo for peacekeeping mission on February 20,2021.We discuss the present situation of artemisinin resistance as well as related treatment,in order to provide an idea of the treatment for artemisinin-resistant falciparum.The patient was admitted with"high fever accompanied by abdominal pain and vomiting for 3 days".He claims that he has recovered from“malaria”three times.Prior to admission,he is treated with artemether at Uvira Level Ⅰ Hospital(details are unknown).Blood smear and rapid diagnostic test indicated the infection of Plasmodium falciparum.Plasmodium density count in blood was 43008/μL.The platelet count was 40×10^(9)/L,alanine aminotransferase was 174 U/L,aspartate aminotransferase was 292 U/L,and total bilirubin was 38.2μmol/L.Two days after treatment with artesunate injection,the patient still has fever with reduced vomiting.Oral compound dihydroartemisinin tablets were used on February 23,and the effect was not good,so we considered the possibility of artemisinin resistance.Seven days of treatment with quinine and doxycycline begined on 25 February,after which the patient′s temperature returned to normal.Re-examination showed that the blood plasmodium was cleared,the liver and kidney functions were normal.The patient was discharged from hospital on March 4.There was no recurrence during the follow-up of 28 days.