4例输入性重症疟疾合并COVID-19诊疗分析

Diagnosis and treatment of 4 cases imported severe malaria and COVID-19 co-infection

对4例重症疟疾合并COVID-19确诊患者的流行病学特征、临床表现、实验室检查、治疗经过及其预后进行回顾性分析,探讨输入性重症疟疾合并新型冠状病毒肺炎(corona virus disease 2019,COVID-19)病例的临床特征及治疗效果,为重症疟疾合并COVID-19防控提供科学依据。4例重症疟疾患者均为同批非洲返国人员,男性,年龄40~54岁,均有非洲工作和生活史;4例均,急性起病,发热、腹泻和乏力纳差,3例畏寒、寒战和恶心呕吐,2例头痛头晕、意识不清、肌肉酸痛和咳嗽2例,1例咳痰、咽痛流涕和小便失禁。4例均行咽拭子新型冠状病毒(2019-nCOV)核酸检测阳性确诊,外周血涂片镜检均找到恶性疟原虫且符合高疟原虫血症,同时均伴有肝功能异常及严重低蛋白血症,肾损害3例,血脂异常3例,高胆红素血症2例,3例降钙素原不同程度升高,乳酸酸中毒2例,低血糖1例;胸部CT提示病毒性肺炎改变1例。4例根据病情不同予个体化治疗方案,均好转出院,复查2019-nCOV核酸及血涂片镜检疟原虫阴性。输入性疟原虫与新型冠状病毒(severe acuterespiratory syndrome coronavirus 2,SARS-CoV-2)共感染病例使临床诊疗更为复杂,应建立新冠肺炎和疟疾同防同诊意识,对本地防控和早期预警重症病例均有重要意义,及时有效地制定治疗方案,提升综合救治效能。

To explore the clinical characteristics,diagnosis and treatment of imported severe malaria and COVID-19 coinfection cases,and to provide scientific basis for epidemic prevention and control measures.The epidemiological characteristics,clinical manifestations,laboratory tests,treatment process and prognosis of 4 cases of severe malaria and COVID-19 co-infection with confirmed diagnosis were analyzed retrospectively.Four cases of severe malaria were African returnees of the same batch,male,aged 40-54 years old,with the same journey track.They all had African work and life history and acute onset.The main clinical manifestations were fever(4/4),chills(3/4),chills(3/4),nausea and vomiting(3/4),diarrhea(4/4),fatigue and anorexia(4/4).Two cases had headache and dizziness,confusion,muscle aches,two cases had cough,one cases had sputum,sore throat and runny urine.All 4 cases were confirmed by positive nucleic acid detection of the new coronavirus(2019-nCOV)in throat swabs.Plasmodium falciparum was found by microscopic examination of peripheral blood smears of all patients,and all of them were consistent with high altitude helminthiasis.All cases were accompanied by abnormal liver function and severe hypoproteinemia,two cases were hyperbilirubinemia,three cases were dyslipidemia,three cases were involved in abnormal tertiary hemogram with different degrees of elevation of procalcitonin,two cases were lactic acid poisoning,and one case was hypoglycemia.One case showed viral pneumonia on chest CT.All cases were treated individually according to the different conditions and were discharged after improvement,and were rechecked for 2019-nCOV nucleic acid and microscopic examination of blood smear negative for Plasmodium.During the global COVID-19 epidemic,the emergence of coinfection cases of con-infection of imported malaria parasites and severe acuterespiratory syndrome coronavirus 2(SARS-CoV-2)makes the clinical diagnosis and treatment more complicated.It is important to establish the awareness of simultaneous prevention and diagnosis of COVID-19 and malaria for local prevention and control and early warning of severe cases,and timely and effective formulation of treatment plan to improve the comprehensive treatment efficiency.