输入性恶性疟疾合并登革热休克综合征的病例分析  

One case of falciparum malaria combined with dengue fever shock syndrome and literature review

作　　者：杨宁[1] 王晗[1] 洪炜[1] 李妍[1] 

机构地区：[1]解放军302医院临床检验医学中心,全军感染病临床实验诊断中心,北京100039

出　　处：《中国热带医学》2016年第6期580-583,共4页China Tropical Medicine

摘　　要：目的分析1例输入性恶性疟疾合并登革热休克综合征病例的诊治过程,为此两种虫媒传染病混合感染的及时就诊、早期诊断和对症治疗提供参考。方法回顾性分析2016年1月6日—1月9日解放军302医院收治的1例输入性恶性疟疾合并登革热休克综合征病例的流行病学、临床表现、辅助检查、诊治情况及死亡原因。结果该患者有明确的非洲疟疾流行区居住史,曾在疫区感染过登革热病毒。其呈不规则发热、发冷、头晕、头痛、周身不适、肩和膝关节疼痛、皮疹、淋巴结肿大、肝脏肿大和白细胞减少;外周血涂片镜下可见红细胞内被染成蓝色的恶性疟原虫纤细环状体,血清检查登革热病毒Ig M抗体呈弱阳性;腹部超声呈肝回声增粗、脾大,胆囊胆汁淤积、胆囊壁毛糙、腹腔积液,于入院后第三天死亡。结论输入性恶性疟疾合并登革热休克综合征患者临床表现复杂,早期诊断、及时合理的治疗是防止此类患者死亡的关键;在常规用药的同时,应重视恶性疟疾的可能耐药问题,及时调整治疗策略,联合治疗,重视病情的监测及并发症的发生。Objective To analyze the diagnosis and treatment process of one case of imported falciparum malariacombined with dengue fever shock syndrome, so as to provide the reference for the early diagnosis and correct treatment of thesimilar cases. Methods The data of epidemiology, clinical manifestations, auxiliary examinations, diagnosis and treatment ofone case of imported falciparum malaria combined with dengue fever shock syndrome were collected and analyzedretrospectively in the hospital from January 6th to January 9th, 2016. Results The patient had a clear history living in themalaria endemic area of Africa, and also was once infected with dengue virus. The manifestations of the patients were fever,chill, dizzy, headache, discomfort, pain of shoulder and knee joints, rash, lymphadenectasis, hepatomegaly, and leucopenia.Plasmodium falciparum was positive in peripheral blood smears by the microscopic examination, and the serum Ig M againstdengue virus was also positive. The patient was diagnosed as falciparum malaria combined with dengue fever shock syndrome,and died 3 days post- admission to hospital from drug resistance and delayed treatment. Conclusion The clinicalmanifestations of patients with imported falciparum malaria combined with dengue fever shock syndrome are complex and theearly diagnosis and treatment is the key to prevent the patient from death, and the drug resistance is also a problem that shouldbe pay much attention to.

关 键 词：恶性疟原虫 恶性疟疾 登革热休克综合征 输入性 流行病学 临床分析 

分 类 号：R531.3[医药卫生—内科学]